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Orale Antikoagulation bei Vorhofflimmern

Differentialtherapie mit Nicht-Vitamin-K-abhängigen oralen Antikoagulanzien (NOAK) und Vitamin-K-Antagonisten (VKA)

Oral anticoagulation in atrial fibrillation: differential therapy with non vitamin K antagonist oral anticoagulants (NOAC) and vitamin K antagonists (VKA)

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MMW - Fortschritte der Medizin Aims and scope

Zusammenfassung

Hintergrund

Nicht-Vitamin-K-abhängige orale Antikoagulanzien (NOAK) haben das Management von Patienten mit oraler Antikoagulation nachhaltig verändert. Es stellt sich die Frage, welche Patienten bevorzugt mit NOAK und welche bevorzugt mit Vitamin-K-Antagonisten (VKA) antikoaguliert werden sollten. Diese Diskussion wurde bisher unzureichend geführt und oft zu pauschal zugunsten der NOAK entschieden.

Methode

Zur Klärung der Frage, welche Form von Antikoagulation — NOAK oder VKA — bei Patienten mit Vorhofflimmern die beste Wahl darstellt, traf sich ein interdisziplinäres Expertenteam.

Ergebnisse und Schlussfolgerungen

Die Experten diskutierten über wesentliche praktische Aspekte der Therapie mit NOAK und VKA. Anhand typischer klinischer Szenarien erarbeiteten sie Hilfestellungen, Anmerkungen und Tipps zum differenzierten Einsatz oraler Antikoagulanzien bei Patienten mit Vorhofflimmern. Als Kriterien dienten u. a. die Praktikabilität in der täglichen medizinischen Praxis, Kontraindikationen, Nebenwirkungen und Interaktionen, aber auch der Patientenwunsch. Die Vor- und Nachteile einer Therapie mit VKA bzw. NOAK wurden in einer Tabelle zusammengefasst.

Abstract

Background

Non-vitamin K-dependent oral anticoagulants (NOAC) have changed the management of patients with oral anticoagulation. This raises the question of which patients should preferably be anticoagulated with NOAC and which preferably with vitamin K antagonists (VKA). This discussion has so far been insufficiently conducted and often decided on a flat-rate basis in favor of the NOAC.

Method

To clarify the question owhich form of anticoagulation — NOAC or VKA — is the best choice for patients with atrial fibrillation, an interdisciplinary team of experts met.

Results and Conclusions

The experts discussed essential practical aspects of NOAC and VKA therapy. Based on typical clinical scenarios, they developed assistance, comments and tips on the differentiated use of oral anticoagulants in patients with atrial fibrillation. A criteria served amongst others practicability in daily medical practice, contraindications, side effects and interactions, but also the patient’s desire. The advantages and disadvantages of therapy with VKA and NOAC were summarized in a table.

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Authors and Affiliations

  1. Gerinnungszentrum Berlin Dr. Sucker, Berlin-Schöneberg, Deutschland

    Christoph Sucker

  2. Klinik für Neurologie, RWTH Aachen University, 52074, Aachen, Deutschland

    Jens Litmathe

  3. Klinik für Innere Medizin und Geriatrie, Evangelisches Klinikum Bethel, Bielefeld, Deutschland

    Heiner K. Berthold

Authors
  1. Christoph Sucker
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  2. Jens Litmathe
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  3. Heiner K. Berthold
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Corresponding author

Correspondence to Jens Litmathe.

Additional information

This article is part of a supplement not sponsored by the industry.

Interessenkonflikt

Dr. Christoph Sucker erhielt Vortagshonorare von Roche Diagnostics und Novartis. Prof. Jens Litmathe erhielt Vortagshonorare von Roche Diagnostics. Prof. Heiner K. Berthold erhielt Vortragshonorare von Novartis und Roche Diagnostics.

An der Expertenrunde nahmen Geriater, Hämostaseologen, Intensivmediziner, Internisten, Hausärzte und Physiologen teil. Die Runde dauerte ca. 8 Stunden mit verschiedenen Workshops und fand auf Einladung der Firma Roche Diagnostics statt.

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Sucker, C., Litmathe, J. & Berthold, H.K. Orale Antikoagulation bei Vorhofflimmern. MMW - Fortschritte der Medizin 161 (Suppl 6), 15–23 (2019). https://doi.org/10.1007/s15006-019-0920-y

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  • DOI: https://doi.org/10.1007/s15006-019-0920-y

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