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Zeitschrift für Gerontologie und Geriatrie

, Volume 51, Issue 3, pp 349–363 | Cite as

Thromboembolieprophylaxe im Alter

  • Gabriele Röhrig
  • Gerald Kolb
  • AG Anämie der Deutschen Gesellschaft für Geriatrie (DGG)
CME
  • 389 Downloads

Zusammenfassung

Der Einsatz von Antikoagulanzien beim älteren Menschen erfolgt im Spannungsfeld zwischen Blutungs- und Thromboembolierisiko. Neben dem Hauptrisikofaktor Alter beeinflussen Komorbiditäten (besonders Niereninsuffizienz) und Polymedikation die Blutungs- bzw. Thromboembolieneigung wesentlich. Doch Alter ist kein Ausschlusskriterium für Antikoagulanzien. Alter gilt als Hauptrisikofaktor für tiefe Venenthrombosen (TVT); auch Vorhofflimmern (VHF) gewinnt mit zunehmendem Lebensalter an Relevanz. Ältere Patienten mit VHF haben ein besonders hohes Risiko, einen Schlaganfall zu erleiden. Da das Blutungsrisiko im Vergleich zum Schlaganfallrisiko geringer ist, profitieren hochaltrige Patienten mit VHF besonders von einer Antikoagulationstherapie. Etablierte Diagnose-Scores helfen bei der Risikoeinschätzung. Dieser Beitrag gibt eine Übersicht über die Epidemiologie thrombembolischer Ereignisse im Alter sowie über aktuelle diagnostische und therapeutische Maßnahmen der Primär- und Sekundärprävention.

Schlüsselwörter

Antikoagulanzien Blutung Tiefe Venenthrombose Embolie Vorhofflimmern 

Thromboembolism prophylaxis in old age

Abstract

Anticoagulation in geriatric patients is challenging regarding the risk of bleeding complications and thromboembolic problems. Age, comorbidities, such as renal insufficiency and polymedication have a vital impact on bleeding and thromboembolic risks; however, age is not an exclusion criterion for withholding anticoagulation. Age is the main risk factor for deep vein thrombosis and atrial fibrillation becomes more relevant with aging. Older patients with atrial fibrillation have a particularly high risk of having a stroke. Therefore, very old patients benefit particularly from oral anticoagulation because the risk of bleeding is outweighed by the clinical benefit of stroke prevention. Risk of bleeding and thromboembolic problems can be easily assessed by established diagnostic tools. This article reviews the epidemiology of thromboembolic problems in the aged as well as current diagnostic and therapeutic steps for primary and secondary prevention.

Keywords

Anticoagulants Bleeding Deep-vein thrombosis Embolisms Atrial fibrillation 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

G. Röhrig und G. Kolb 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, ein Teil von Springer Nature 2018

Authors and Affiliations

  • Gabriele Röhrig
    • 1
  • Gerald Kolb
    • 2
  • AG Anämie der Deutschen Gesellschaft für Geriatrie (DGG)
  1. 1.Zentrum für spezialisierte geriatrische DiagnostikMVZ Medicum Köln-OstKölnDeutschland
  2. 2.Medizinische Klinik, Fachbereich GeriatrieBonifatius Hospital Lingen (Ems)Lingen (Ems)Deutschland

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