Notfall + Rettungsmedizin

, Volume 20, Issue 3, pp 251–264 | Cite as

Nicht-Vitamin-K-abhängige orale Antikoagulanzien

Notfallmanagement bei Patienten mit Blutungen unter oraler Antikoagulation
CME

Zusammenfassung

Trotz des breiten Einsatzes nicht-Vitamin-K-abhängiger oraler Antikoagulanzien (NOAK) sowie Empfehlungen von Zulassungsbehörden und interdisziplinären Expertengremien zum Umgang in der Blutungssituation unter NOAK-Antikoagulation besteht insbesondere in Krankenhäusern ohne hämostaseologischen Schwerpunkt große Handlungsunsicherheit. Bei aus klinischer Sicht leichten Blutungen sind die medizinische Überwachung dieser Patienten und die Verzögerung der nächsten Einnahme oder das passagere Absetzen anzuraten. Bei mittelschweren bis schweren Blutungen richten sich die primären Maßnahmen auf die Stabilisierung der Herz-Kreislauf-Funktion und parallel auf die Behandlung, je nach Lokalisation des Blutungsherdes. Vital bedrohliche, z. B. intrakranielle Blutungen erfordern neben den Maßnahmen der hämodynamischen Stabilisierung ein spezielles Hämostasemanagement, das vorwiegend klinisch orientiert sein sollte.

Schlüsselwörter

Blutung Direkte Faktor-Xa-Inhibitoren Dabigatran Antidot Gerinnungstests 

Non-vitamin K‑dependent oral anticoagulants

Emergency management in patients with bleeding under oral anticoagulation

Abstract

Despite the widespread use of non-vitamin K‑dependent oral anticoagulants (NOAC), recommendations from regulatory agencies and interdisciplinary expert panels on handling bleeding situations with NOAC, uncertainty in dealing with these situations still exists especially in hospitals with a low emphasis on hemostatics. In cases of mild bleeding from a clinical perspective, medical surveillance of these patients and delay of the next intake or temporary discontinuation are recommended. In cases of moderate to severe bleeding, the primary measures are focused on stabilization of cardiopulmonary and circulatory functions and simultaneously on the treatment, depending on the localization of the source of bleeding. In cases of life-threatening bleeding, such as intracranial hemorrhage, special hemostatic management is necessary in addition to hemodynamic stabilization measures, which should predominantly be oriented to the clinical severity.

Keywords

Bleeding Direct factor Xa inhibitors Dabigatran Antidote Blood coagulation tests 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

J. Koscielny gibt folgende Interessenkonflikte an: Vortragshonorare von Aspen, Bayer Health Care Pharmaceuticals, Daiichi Sankyo, Boehringer Ingelheim, CSL Behring, Sanofi-Aventis, Pfizer, BMS, Mitsubishi Pharma, Ferring GmbH, Mylan Healthcare GmbH und Novo Nordisk. J. Koscielny war in den vergangenen 3 Jahren zudem als medizinischer Berater für CSL Behring International, Bayer HealthCare Pharmaceuticals (national und international) und Novo Nordisk (national) tätig. C. Rosenthal gibt folgende Interessenkonflikte an: Vortragshonorare von Daiichi Sankyo. Im Zusammenhang mit dem Thema des vorliegenden Beitrags hat C. von Heymann in den vergangenen 3 Jahren Honorare für Vorträge und Beratungstätigkeiten sowie Reisekostenerstattungen von Bayer AG, Boehringer Ingelheim, Pfizer GmbH, Bristol Myers Squibb, Daiichi Sankyo, CSL Behring, Mitsubishi Pharma, Novo Nordisk, Ferring GmbH, TEM International, Mylan Healthcare GmbH, Sanofi-Aventis und HICC GbR erhalten. Im selben Zeitraum hat er Forschungsgelder von Bayer AG, Boehringer Ingelheim und Bristol Myers Squibb erhalten.

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

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Copyright information

© Springer Medizin Verlag GmbH 2017

Authors and Affiliations

  1. 1.Gerinnungsambulanz mit Hämophiliezentrum im ambulanten Gesundheitszentrum (AGZ)Charité Universitätsmedizin Berlin, Campus MitteBerlinDeutschland
  2. 2.Klinik für Anästhesiologie mit Schwerpunkt operative IntensivmedizinCharité Universitätsmedizin Berlin, Campus Virchow KlinikumBerlinDeutschland
  3. 3.Klinik für Anästhesie, Intensivmedizin, Notfallmedizin und SchmerztherapieVivantes Klinikum im FriedrichshainBerlinDeutschland

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