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Blutungen unter direkten oralen Antikoagulanzien

Auftreten und Therapie bei Intensivpatienten

Hemorrhage under direct oral anticoagulants

Occurrence and treatment in intensive care patients

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Zusammenfassung

Die Verwendung von Antikoagulanzien ist mit einem erhöhten Blutungsrisiko verbunden und Blutungskomplikationen können lebensbedrohlich sein. Derzeit liegt der Fokus auf Blutungen unter direkten oralen Antikoagulanzien (DOAK), da Antidote oder spezifische Maßnahmen für einige der DOAK fehlen. Darüber hinaus können routinemäßige Gerinnungstests nicht verwendet werden, um den Grad der Antikoagulation unter DOAK zu bestimmen. Dadurch wird es schwieriger festzustellen, ob der gerinnungshemmende Effekt nicht mehr vorhanden ist. In diesem Artikel werden die Behandlung von Blutungen bei Patienten mit DOAK auf der Intensivstation, die Indikationen für die Substanzen sowie Einzelheiten ihrer Verabreichung und Überwachung dargestellt.

Abstract

The use of anticoagulants is associated with an increased risk of bleeding and nevertheless bleeding complications can be lifethreatening. The focus is on bleeding under direct oral anticoagulants (DOAC) because antidotes and specific measures are lacking for some DOACs. Furthermore, routinely carried out clotting tests cannot be used to determine the degree of anticoagulation under DOACs. Therefore, it becomes difficult to determine whether the coagulation inhibition effect is present. This article presents the treatment of hemorrhage in patients with DOACs in the intensive care unit. Further, the indications for DOACS and details of administration and monitoring are presented.

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Authors and Affiliations

  1. Klinik für Kardiologie und Allgemeine Innere Medizin, Städtisches Klinikum Solingen, Gotenstraße 1, 42653, Solingen, Deutschland

    H. M. Hoffmeister

  2. Klinik für Innere Medizin – Kardiologie, Angiologie, Nephrologie und konservative Intensivmedizin, Vivantes Klinikum Neukölln, Berlin, Deutschland

    H. Darius

  3. Medizinische Klinik II, Kardiologie, Angiologie, Internistische Intensivmedizin, St. Marien-Krankenhaus, Siegen, Deutschland

    M. Buerke

  4. Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, Halle/Saale, Deutschland

    M. Buerke

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  1. H. M. Hoffmeister
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Correspondence to H. M. Hoffmeister.

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H. M. Hoffmeister, H. Darius und M. Buerke 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

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Hoffmeister, H.M., Darius, H. & Buerke, M. Blutungen unter direkten oralen Antikoagulanzien. Med Klin Intensivmed Notfmed 113, 284–292 (2018). https://doi.org/10.1007/s00063-018-0436-8

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  • DOI: https://doi.org/10.1007/s00063-018-0436-8

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