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Eingriffe unter NOAK

Was ist möglich?

Procedures on patients receiving NOACs

What’s possible?

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Zusammenfassung

Nicht-Vitamin-K-antagonistische orale Antikoagulanzien (NOAK) werden in den letzten Jahren vermehrt bei Patienten mit nichtvalvulärem Vorhofflimmern, venöser Thrombose und Lungenembolie eingesetzt. Allerdings sind die Erfahrungen mit diesen neuen Substanzen im Rahmen des periinterventionellen, perioperativen und intensivmedizinischen Managements noch sehr eingeschränkt. Aufgrund der fehlenden Evidenz basieren die aktuellen Empfehlungen zum Umgang mit Patienten unter NOAK in diesem Rahmen auf Analysen der Pharmakokinetik in Kombination mit patientenspezifischen Charakteristiken, dem jeweiligen Blutungsrisiko des geplanten Eingriffs und der Dringlichkeit der Prozedur. Dieser Review fasst die Evidenz und Empfehlungen zum optimalen periinterventionellen/perioperativen/intensivmedizinischen antithrombotischen Management bei Patienten unter NOAK-Therapie zusammen.

Abstract

Non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly used in patients with deep vein thrombosis (DVT), pulmonary embolism (PE) and atrial fibrillation (AF). However, there is insufficient data concerning the periinterventional, perioperative, and intensive care management of patients on NOACs. Therefore, the recommendations regarding this management rely on pharmacokinetics of the particular NOAC in combination with the individual patient’s characteristics, bleeding risk of the planned intervention/surgery, and urgency of the procedure. This review summarizes evidence and recommendations regarding the optimal periinterventional/perioperative antithrombotic management of patients on NOACs.

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Förderung

Das Entstehen dieser Arbeit wurde durch die Forschungskommission der Heinrich-Heine-Universität Düsseldorf (A.P.: No. 16-2014; P.H.: 30-2014) finanziell unterstützt.

Author information

Correspondence to PD Dr. med. A. Polzin.

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Interessenkonflikt

A. Polzin, M. Kelm und P. Horn geben an, dass kein Interessenkonflikt besteht.

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

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M. Buerke, Siegen

H.M. Hoffmeister, Solingen

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Polzin, A., Kelm, M. & Horn, P. Eingriffe unter NOAK. Med Klin Intensivmed Notfmed 112, 117–124 (2017). https://doi.org/10.1007/s00063-016-0239-8

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Schlüsselwörter

  • Blutung
  • Antikoagulanzien
  • Perioperatives Management
  • Intensivmedizin
  • Pharmakokinetik

Keywords

  • Bleeding
  • Anticoagulants
  • Perioperative care
  • Intensive care
  • Pharmacokinetics