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Moderne Therapie tiefer Venenthrombosen und der Lungenarterienembolie

Modern treatment of deep vein thrombosis and pulmonary embolism

  • Arzneimitteltherapie
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Zusammenfassung

Die Virchow-Trias ist seit 100 Jahren bekannt. Die Entwicklung der therapeutischen Möglichkeiten in dieser Zeit war enorm. Heute ist die Antikoagulation viel differenzierter. Vier neue orale Substanzen haben die klassische Behandlung mit Vitamin-K-Antagonisten in der Angiologie abgelöst. Eine standardisierte Dosis ist möglich. Das Monitoring der Gerinnungsparameter entfällt, aber die Kontrolle der Nierenfunktion wird wichtig. Direkte orale Antikoagulanzien sind für die Behandlung der venösen Thrombosen und Lungenarterienembolie zugelassen, bisher allerdings nicht in der Schwangerschaft oder bei Kindern. Schwere, insbesondere intrazerebrale, Blutungskomplikationen sind seltener. Die Inzidenz der venösen Thromboembolien ist weiterhin hoch. Eine besondere Bedeutung kommt hierbei der Adipositas und den Tumorleiden zu. Der „therapeutische Pakt“ mit dem Patienten erfordert von uns Ärzten das Beherrschen der „sprechenden Medizin“.

Abstract

Virchow’s triad has been known for a 100 years. The development of therapeutic possibilities during this time was enormous. Today anticoagulant therapy is much more differentiated. Four new oral substances have replaced the traditional treatment with vitamin K antagonists in angiology. A standardized dosage is available. The monitoring of the coagulation parameters is no longer necessary, but it is important to monitor renal function. Direct oral anticoagulants are approved for the treatment of venous thrombosis and pulmonary embolism, but not during pregnancy or in children. Severe bleeding complications, especially intracerebral bleeding, are less common. The incidence of venous thromboembolism is still high. Obesity and cancer are of particular importance. The “therapeutic pact” with the patient requires that physicians master the art of “talking medicine”.

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Abbreviations

aPTT:

Aktivierte partielle Thromboplastinzeit

ASS:

Acetylsalicylsäure

LAE:

Lungenarterienembolie

DOAK:

Direkte orale Antikoagulanzien

FDX:

Fondaparinux

INR:

International Normalized Ratio

NMH:

Niedermolekulares Heparin

PPSB:

Prothrombinkomplexkonzentrat

TBVT:

Tiefe Beinvenenthrombose

UAW:

Unerwünschte Arzneimittelwirkungen

UFH:

Unfraktioniertes Heparin

TPZ:

Thromboplastinzeit

VKA:

Vitamin-K-Antagonist

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Authors and Affiliations

  1. Innere Medizin, Angiologie und Hämostaseologie, Cardioangiologisches Centrum Bethanien (CCB), Im Prüfling 23, 60389, Frankfurt am Main, Deutschland

    J. Renczes &  E. Lindhoff-Last

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Correspondence to J. Renczes.

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Interessenkonflikt

J. Renczes: Honorare von Pharmaunternehmen für Vorträge und Vorsitze: Bayer Vital, Daiichi Sankyo. E. Lindhoff-Last: Beratungstätigkeit für Pharmaunternehmen: Bayer Vital, Boehringer Ingelheim, Pfizer/BMS, Daiichi Sankyo; Honorare von Pharmaunternehmen für Vorträge und Vorsitze: Bayer Vital, Boehringer Ingelheim, Pfizer/BMS, Daiichi Sankyo, CSL Behring, Aspen; Finanzierung wissenschaftlicher Untersuchungen: Bayer Vital, BMS/Pfizer, Daiichi Sankyo, CSL Behring.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Renczes, J., Lindhoff-Last, E. Moderne Therapie tiefer Venenthrombosen und der Lungenarterienembolie. Internist 60, 644–655 (2019). https://doi.org/10.1007/s00108-019-0609-4

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