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Direkte Antikoagulanzien bei Vorhofflimmern

Update 2014

Direct anticoagulants for atrial fibrillation

Update 2014

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Zusammenfassung

Vitamin-K-Antagonisten (VKA) waren jahrzehntelang der Standard in der Schlaganfallprophylaxe bei Vorhofflimmern. Wegen der bekannten Unannehmlichkeiten (u. a. schwankende Wirkspiegel durch alimentäre und medikamentöse Interaktionen, was regelmäßige Gerinnungskontrollen erfordert) wurden in den vergangenen Jahren alternative Substanzen, sog. direkte orale Antikoagulanzien (DOAC) entwickelt und in großen klinischen Studien gegenüber VKA getestet. Zu den DOAC gehören das direkte Antithrombin Dabigatran und die direkten Faktor-Xa-Inhibitoren Rivaroxaban, Apixaban und Edoxaban. Aufgrund eines gut vorhersehbaren Dosis-Wirkungs-Profils sind in der klinischen Routine keine Laborkontrollen erforderlich. DOAC zeigen eine im Vergleich zu Warfarin gleichwertige bis bessere Effektivität bei der Verhinderung von Schlaganfällen und systemischen Embolien bei einem günstigeren Sicherheitsprofil, welches sich aus einer vergleichbaren bis geringeren Rate an schweren Blutungskomplikationen und einer signifikanten Reduktion von intrakraniellen Blutungen ergibt.

Abstract

For several decades vitamin K antagonists (VKA) were the standard for stroke prevention in atrial fibrillation. Because of inconvenience associated with their use (frequently VKA levels cannot be consistently maintained within the therapeutic range, e.g. due to food and drug interactions, which necessitates regular control of international normalized ratios) alternative compounds have recently been developed, the direct oral anticoagulants (DOACs) dabigatran (a direct antithrombin) as well as rivaroxaban, apixaban and edoxaban (direct factor Xa inhibitors). All these agents show a predictable pharmacokinetic profile making routine laboratory controls unnecessary. Moreover, DOACs do not only show a similar or even better efficacy, but also a more attractive safety profile in terms of similar or less major bleeding complications, where all DOACs significantly reduce the rate of intracranial bleeding when compared to VKAs. This review summarizes the pharmacological characteristics and clinical study results of DOACs that have been tested in phase 3 trials.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. T. Höchtl-Hainzl und K. Huber geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. 3. Medizinische Abteilung mit Kardiologie und Internistischer Intensivmedizin, Wilhelminenspital, Montleartstr. 37, A-1160, Wien, Österreich

    T. Höchtl-Hainzl & K. Huber

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  1. T. Höchtl-Hainzl
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  2. K. Huber
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Correspondence to T. Höchtl-Hainzl.

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Höchtl-Hainzl, T., Huber, K. Direkte Antikoagulanzien bei Vorhofflimmern. Herz 39, 357–368 (2014). https://doi.org/10.1007/s00059-014-4092-3

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