Nicht-Vitamin-K-abhängige orale Antikoagulanzien und Plättchenhemmer in der Herzchirurgie

Herausforderungen und Nutzen
Perioperative Medizin
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Zusammenfassung

Die nicht-Vitamin-K-abhängigen oralen Antikoagulanzien (NOAK) werden in den letzten Jahren immer häufiger zur Behandlung von Patienten mit nichtvalvulärem Vorhofflimmern, tiefer Venenthrombose und Lungenembolie eingesetzt. Die relativ neuen P2Y12-Inhibitoren, Prasugrel und Ticagrelor, sind in Kombination mit Acetylsalicylsäure auch zur Standardtherapie der dualen Plättchenhemmung bei Patienten mit Z. n. Koronarinterventionen aufgrund eines akuten Koronarsyndroms geworden. Des Weiteren werden NOAK in Kombination mit Plättchenhemmern bei Patienten mit Koronarinterventionen und Vorhofflimmern zunehmend häufig eingesetzt. Dementsprechend sind u. a. die Herzchirurgen mit dem Problem konfrontiert, die Patienten, die eine NOAK oder eine antithrombotische Kombinationstherapie erhalten, elektiv bzw. dringend/notfallmäßig zu operieren. Die aktuellen Empfehlungen hinsichtlich des perioperativen Managements solcher Patienten basieren auf verschiedenen Faktoren, wie Halbwertszeit der Medikamente, Nierenfunktion der Patienten, Eigenschaften und Lokalisation der implantierten Stents, Zeitraum nach Stent-Implantation bzw. Art und Dringlichkeit der Prozedur. Der vorliegende Review fasst die wachsende Evidenz und Empfehlungen zum optimalen perioperativen Management der Patienten mit verschiedenen Kombinationen der antithrombotischen Therapie zusammen.

Schlüsselwörter

Perioperative Versorgung Antiaggregation Vorhofflimmern Blutung Bridging 

Non-vitamin K‑dependent oral anticoagulants and antiplatelet treatment in cardiac surgery

Challenges and benefits

Abstract

The non-vitamin K‑dependent oral anticoagulants (NOAC) are being used for treatment of non-valvular atrial fibrillation (AF), deep vein thrombosis and pulmonary embolism with increasing frequency. The relatively new P2Y12 receptor inhibitors prasugrel and ticagrelor, are meanwhile the mainstay of dual antiplatelet therapy (DAPT) in combination with acetylsalicylic acid after percutaneous coronary interventions (PCI) in patients with acute coronary syndrome. Moreover, triple as well as dual therapy with NOAC and antiplatelet drugs is usually necessary for patients with AF who undergo PCI. Thus, cardiac surgeons as well as other surgeons will more frequently face the problem of treating patients who are on various antithrombotic regimens and need elective, emergency or urgent surgery. The current recommendations for perioperative management of such patients are based on different factors, such as the half-life of the drugs, renal function of patients, specific properties and localization of coronary stents, the time period after coronary angioplasty as well as the type and urgency of surgical procedures. This review summarizes the increasing evidence and current recommendations on optimal perioperative management of patients treated with various combinations of antithrombotic drugs.

Keywords

Perioperative care Antiaggregation Atrial fibrillation Bleeding Bridging 
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Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

R. Jorbenadze und M. Gawaz geben an, dass kein Interessenkonflikt besteht.

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

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Copyright information

© Springer Medizin Verlag GmbH 2017

Authors and Affiliations

  1. 1.Medizinische Klinik III (Kardiologie)Universitätsklinikum TübingenTübingenDeutschland

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