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Antikoagulation bei Patienten mit chronischer Niereninsuffizienz

Empfehlungen der Arbeitsgemeinschaft „Herz – Niere“ der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung und der Deutschen Gesellschaft für Nephrologie

Anticoagulation in patients with chronic kidney disease

Recommendations from the working group “Heart–Kidney” of the German Cardiac Society and the German Society of Nephrology

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Zusammenfassung

Indikationen zur Antikoagulation sind im Wesentlichen venöse thromboembolische Ereignisse, mechanische Herzklappen und Vorhofflimmern bei einem entsprechenden Risikoscore. Die in Studien überwiegend an nierengesunden Patienten erhobenen Daten können jedoch nicht immer auf Patienten mit chronischer Niereninsuffizienz übertragen werden. Die nicht-Vitamin-K-abhängigen oralen Antikoagulanzien (NOAK) sind bei höhergradiger Niereninsuffizienz überwiegend nicht empfohlen bzw. kontraindiziert. In Observationsstudien profitieren Dialysepatienten mit Vorhofflimmern nicht von einer Antikoagulation mit Kumarinen. Prospektive Studien stehen aus.

Abstract

Indications for anticoagulation are thromboembolic events, prosthetic heart valves, and atrial fibrillation with a corresponding risk score. Clinical trials have excluded patients with advanced chronic kidney disease and these data cannot be always generalized to patients with chronic kidney disease. Non-vitamin K antagonist oral anticoagulants (NOACs) are mostly not recommended or are contraindicated in advanced stages of chronic kidney disease. Observational studies have shown that dialysis patients with atrial fibrillation do not profit from coumarin anticoagulants; prospective studies are lacking.

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Correspondence to PD Dr. G. Schlieper.

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Interessenkonflikt

D. Fliser weist auf folgende Beziehung hin: Honorar von Daiichi-Sankyo. G. Schlieper, V. Schwenger, A. Remppis, T. Keller, R. Dechend, S. Massberg, S. Baldus, T. Weinreich, G. Hetzel, J. Floege und F. Mahfoud geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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M. Wehling, Mannheim

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Schlieper, G., Schwenger, V., Remppis, A. et al. Antikoagulation bei Patienten mit chronischer Niereninsuffizienz. Internist 58, 512–521 (2017). https://doi.org/10.1007/s00108-017-0220-5

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Schlüsselwörter

  • Vorhofflimmern
  • Nierenerkrankung
  • Antikoagulanzien
  • Phenprocoumon
  • Warfarin

Keywords

  • Atrial fibrillation
  • Renal disease
  • Anticoagulants
  • Phenprocoumon
  • Warfarin