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Neue orale Antikoagulanzien und Niereninsuffizienz

New oral anticoagulants and chronic kidney disease

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Zusammenfassung

Die absehbare demografische Entwicklung führt zu einer Zunahme an Patienten mit venösen Thromboembolien (VTE) und mit Vorhofflimmern. Die Antikoagulationsbehandlung dieser Krankheitsbilder wird durch die wachsende Zahl an Patienten mit Niereninsuffizienz kompliziert. Sowohl die Wirksamkeit als auch die Sicherheit einer Antikoagulationsbehandlung ist hier eingeschränkt. Neue orale Antikoagulanzien (NOAK) werden in unterschiedlichem Maße renal eliminiert. Daher können sie bei Niereninsuffizienz kumulieren und ein erhöhtes Blutungsrisiko bedingen. Umso wichtiger ist die genaue Kenntnis der Pharmakologie der neuen Substanzen. Die Analyse der vorliegenden Evidenz im Hinblick auf Patienten mit eingeschränkter Nierenfunktion erlaubt wichtige Rückschlüsse für den praktischen Alltag.

Abstract

The prevalence of atrial fibrillation and venous thromboembolism will rise over the next decades due to foreseeable demographic developments. Anticoagulation treatment for these patients will become increasingly challenging due to the rising prevalence of chronic kidney disease (CKD), which is associated with both an increased risk of bleeding and impaired efficacy of oral anticoagulation (OAC). New oral anticoagulants (NOAC) are excreted by the kidneys and may thus accumulate in patients with CKD leading to an increased risk of bleeding; therefore, the pharmacological properties of NOACs have to be considered in order to avoid serious complications. Analysis of the currently available evidence for patients with CKD provides important insights for everyday clinical practice.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Produkt (Firma): Apixaban (BMS/Pfizer), Dabigatran (Boehringer-Ingelheim), Edoxaban (Daiichi-Sankyo), Rivaroxaban (Bayer). Verbindung: Leiter der klinischen Prüfung (Deutschland) für Studien zur Therapie und Prophylaxe der VTE.

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  1. Medizinische Klinik IV – Max-Ratschow-Klinik für Angiologie, Klinikum Darmstadt GmbH, Grafenstr. 9, 64283, Darmstadt, Deutschland

    R.M. Bauersachs

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Correspondence to R.M. Bauersachs.

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Bauersachs, R. Neue orale Antikoagulanzien und Niereninsuffizienz. Internist 53, 1431–1444 (2012). https://doi.org/10.1007/s00108-012-3146-y

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