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Neue orale Antikoagulanzien zur Prophylaxe von Schlaganfällen

Ergebnis einer Expertenkonferenz zum praktischen Einsatz bei geriatrischen Patienten

New oral anticoagulants for prophylaxis of stroke

Results of an expert conference on practical use in geriatric patients

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Zusammenfassung

Geriatrische Patienten mit nichtvalvulärem Vorhofflimmern (VHF) erhalten zunehmend neue orale Antikoagulanzien (NOAK) zur Schlaganfallprophylaxe. Das vorliegende Manuskript berichtet die Ergebnisse einer Expertenrunde zum praktischen Einsatz der NOAK bei geriatrischen Patienten. Eine interdisziplinäre Expertengruppe diskutierte die aktuelle Situation der Schlaganfallprävention bei geriatrischen Patienten und ihr praktisches Management in der täglichen klinischen Praxis. Das Thema wurde durch gezielte Impulsreferate und kritische Analyse als Grundlage für den Expertenkonsens diskutiert. Die wichtigsten Aspekte sind in diesem Beitrag zusammengefasst.In der VHF-Leitlinie der „European Society of Cardiology“ (ESC) werden für die Antikoagulation bei Patienten mit nichtvalvulärem VHF NOAK bevorzugt und Vitamin-K-Antagonisten (VKA) als Alternative empfohlen. Momentan finden die Faktor-Xa-Inhibitoren Apixaban und Rivaroxaban und der Thrombininhibitor Dabigatran als NOAK bei VHF klinische Anwendung. Für diese Medikamente bestehen viele Gemeinsamkeiten, für die differenzierte Pharmakotherapie aber auch wichtige Unterschiede. Die NOAK haben bei geriatrischen Patienten eine Reihe von Vorteilen gegenüber den VKA, vorrangig durch das bessere Nutzen-Risiko-Verhältnis aufgrund einer verminderten Zahl von Blutungsereignissen, und ein insgesamt geringeres Risiko für Arzneimittelinteraktionen. Hervorzuheben ist auch die einfachere Handhabung der NOAK im Alltag (kein INR-Monitoring erforderlich und unkompliziertere Unterbrechungen der Therapie bei geplanten Interventionen). Für geriatrische Patienten sollten vorzugsweise NOAK gewählt werden, die auch bei reduzierter Nierenfunktion eingesetzt werden können. Spiegelbestimmungen der NOAK werden zwar noch nicht flächendeckend angeboten, sind jedoch nicht mehr teuer und sollten bei Erfordernis (z. B. Adhärenzkontrolle bei Demenz) auch durch den niedergelassenen Arzt veranlasst werden. Eine regelmäßige Überprüfung der Indikationsstellung der NOAK (wie auch aller anderen Medikamente des Patienten) ist unabdingbar. Insgesamt sollten NOAK den hierfür geeigneten Patienten nicht vorenthalten werden.

Abstract

Geriatric patients with non-valvular atrial fibrillation (AF) are increasingly being treated with novel oral anticoagulants (NOAC) to prevent ischemic stroke. This article highlights the outcome of an expert meeting on the practical use of NOAC in elderly patients. An interdisciplinary group of experts discussed the current situation of stroke prevention in geriatric patients and its practical management in daily clinical practice. The topic was examined through focused impulse presentations and critical analyses as the basis for the expert consensus. The key issues are summarized in this paper. The European Society of Cardiology (ESC) guidelines from 2012 for the management of patients with non-valvular AF recommend NOAC as the preferred treatment and vitamin K antagonists (VKA) only as an alternative option. Currently, the NOAC factor Xa inhibitors apixaban and rivaroxaban and the thrombin inhibitor dabigatran are more commonly used in clinical practice for patients with AF. Although these drugs have many similarities and are often grouped together it is important to recognize that the pharmacology and dose regimes differ between compounds. Especially n elderly patients NOAC drugs have some advantages compared to VKA, e.g. less drug-drug interactions with concomitant medication and a more favorable risk-benefit ratio mostly driven by the reduction of bleeding. Treatment of anticoagulation in geriatric patients requires weighing the serious risk of stroke against an equally high risk of major bleeding and pharmacoeconomic considerations. Geriatric patients in particular have the greatest benefit from NOAC, which can also be administered in cases of reduced renal function. Regular control of the indications is indispensable, as also for all other medications of the patient. The use of NOAC should certainly not be withheld from geriatric patients who have a clear need for oral anticoagulation.

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Literatur

  1. Andrade SE, Martinez C, Walker AM (1998) Comparative safety evaluation of non-narcotic analgesics. J Clin Epidemiol 51:1357–1365

    Article  CAS  PubMed  Google Scholar 

  2. Avecilla ST, Ferrell C, Chandler WL et al (2012) Plasma-diluted thrombin time to measure dabigatran concentrations during dabigatran etexilate therapy. Am J Clin Pathol 137:572–574

    Article  PubMed  Google Scholar 

  3. Bahrmann P, Wehling M, Ropers D et al (2015) Optimal Stroke Prevention in the Geriatric Patient with Atrial Fibrillation: Position Paper of an Interdisciplinary Expert Panel. Drug Res 65:505-14

    Article  PubMed  Google Scholar 

  4. Barat I, Andreasen F, Damsgaard EM (2001) Drug therapy in the elderly: what doctors believe and patients actually do. Br J Clin Pharmacol 51:615–622

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Camm A, Lip G, Atar D et al (2012) 2012 focused update of the ESC guidelines on the management of atrial fibrillation. Eur Heart J 33:2719–2747

    Article  PubMed  Google Scholar 

  6. Camm AJ, Kirchhof P, Lip GY et al (2010) Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 31:2369–2429

    Article  PubMed  Google Scholar 

  7. Chronopoulos A, Cruz DN, Ronco C (2010) Hospital-acquired acute kidney injury in the elderly. Nat Rev Nephrol 6:141–149

    Article  PubMed  Google Scholar 

  8. Cockcroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16:31–41

    Article  CAS  PubMed  Google Scholar 

  9. Connolly SJ, Eikelboom J, Joyner C et al (2011) Apixaban in patients with atrial fibrillation. N Engl J Med 364:806–817

    Article  CAS  PubMed  Google Scholar 

  10. Conroy SP, Ansari K, Williams M et al (2014) A controlled evaluation of comprehensive geriatric assessment in the emergency department: the ‚Emergency Frailty Unit‘. Age Ageing 43:109–114

    Article  PubMed  PubMed Central  Google Scholar 

  11. De Caterina R, Husted S, Wallentin L et al (2012) New oral anticoagulants in atrial fibrillation and acute coronary syndromes: ESC Working Group on Thrombosis-Task Force on Anticoagulants in Heart Disease position paper. J Am Coll Cardiol 59:1413–1425

    Article  PubMed  Google Scholar 

  12. De Caterina R, Husted S, Wallentin L et al (2013) Vitamin K antagonists in heart disease: current status and perspectives (Section III). Position Paper of the ESC Working Group on Thrombosis – Task Force on Anticoagulants in Heart Disease. Thromb Haemost 110:1087–1107

    Article  PubMed  Google Scholar 

  13. Deal EN, Pope H, Ross W (2014) Apixaban use among patients with severe renal impairment. Ann Pharmacother 48:1667

    Article  PubMed  Google Scholar 

  14. Deitelzweig S, Amin A, Jing Y et al (2013) Medical costs in the US of clinical events associated with oral anticoagulant (OAC) use compared to warfarin among non-valvular atrial fibrillation patients>/= 75 and < 75 years of age, based on the ARISTOTLE, RE-LY, and ROCKET-AF trials. J Med Econ 16:1163–1168

    Article  PubMed  Google Scholar 

  15. Delafuente JC (2003) Understanding and preventing drug interactions in elderly patients. Crit Rev Oncol Hematol 48:133–143

    Article  PubMed  Google Scholar 

  16. Deutsche Gesellschaft Für Geriatrie Der geriatrische Patient (Definition). http://www.dggeriatrie.de/. Zugegriffen: 9. Nov. 2014

  17. Eriksson M, Norrving B, Terent A et al (2008) Functional outcome 3 months after stroke predicts long-term survival. Cerebrovasc Dis 25:423–429

    Article  PubMed  Google Scholar 

  18. Folstein MF, Folstein SE, Mchugh PR (1975) „Mini-mental state“. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198

    Article  CAS  PubMed  Google Scholar 

  19. Fuster V, Ryden LE, Cannom DS et al (2011) 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 123:e269–e367

    Article  PubMed  Google Scholar 

  20. Gallagher AM, Rietbrock S, Plumb J et al (2008) Initiation and persistence of warfarin or aspirin in patients with chronic atrial fibrillation in general practice: do the appropriate patients receive stroke prophylaxis? J Thromb Haemost 6:1500–1506

    Article  CAS  PubMed  Google Scholar 

  21. Gellad WF, Grenard JL, Marcum ZA (2011) A systematic review of barriers to medication adherence in the elderly: looking beyond cost and regimen complexity. Am J Geriatr Pharmacother 9:11–23

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ghate SR, Biskupiak J, Ye X et al (2011) All-cause and bleeding-related health care costs in warfarin-treated patients with atrial fibrillation. J Manag Care Pharm 17:672–684

    PubMed  Google Scholar 

  23. Go AS, Hylek EM, Phillips KA et al (2001) Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 285:2370–2375

    Article  CAS  PubMed  Google Scholar 

  24. Graham DJ, Reichman ME, Wernecke M et al (2015) Cardiovascular, bleeding, and mortality risks in elderly medicare patients treated with dabigatran or warfarin for non-valvular atrial fibrillation. Circulation 131(2):157–164

    Article  CAS  PubMed  Google Scholar 

  25. Granger CB, Alexander JH, Mcmurray JJV et al (2011) Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 365:981–992

    Article  CAS  PubMed  Google Scholar 

  26. Granziera S, Cohen AT, Nante G et al (2015) Thromboembolic prevention in frail elderly patients with atrial fibrillation: a practical algorithm. J Am Med Dir Assoc 16(5):358–364

    Article  PubMed  Google Scholar 

  27. Halvorsen S, Atar D, Yang H et al (2014) Efficacy and safety of apixaban compared with warfarin according to age for stroke prevention in atrial fibrillation: observations from the ARISTOTLE trial. Eur Heart J 35:1864–1872

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Hankey GJ, Spiesser J, Hakimi Z et al (2007) Time frame and predictors of recovery from disability following recurrent ischemic stroke. Neurology 68:202–205

    Article  CAS  PubMed  Google Scholar 

  29. Haynes RB, Ackloo E, Sahota N et al (2008) Interventions for enhancing medication adherence. Cochrane Database Syst Rev (2):CD000011

  30. Healey JS, Eikelboom J, Douketis J et al (2012) Periprocedural bleeding and thromboembolic events with dabigatran compared with warfarin: results from the Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) randomized trial. Circulation 126:343–348

    Article  CAS  PubMed  Google Scholar 

  31. Hohnloser SH, Hijazi Z, Thomas L et al (2012) Efficacy of apixaban when compared with warfarin in relation to renal function in patients with atrial fibrillation: insights from the ARISTOTLE trial. Eur Heart J 33:2821–2830

    Article  CAS  PubMed  Google Scholar 

  32. Kaatz S, Kouides PA, Garcia DA et al (2012) Guidance on the emergent reversal of oral thrombin and factor Xa inhibitors. Am J Hematol 87(Suppl 1):S141–S145

    Article  CAS  PubMed  Google Scholar 

  33. Kalbe E, Kessler J, Calabrese P et al (2004) DemTect: a new, sensitive cognitive screening test to support the diagnosis of mild cognitive impairment and early dementia. Int J Geriatr Psychiatry 19:136–143

    Article  CAS  PubMed  Google Scholar 

  34. Kannel WB, Benjamin EJ (2008) Status of the epidemiology of atrial fibrillation. Med Clin North Am 92:17–40

    Article  PubMed  PubMed Central  Google Scholar 

  35. Kasprick L, Flohr J (2014) LIQUID – Leipziger Intersektorales Quaritiersnahes InformationsDesign – von der Planung- bis zur Umsetzungsphase: Ein Projekt aus der Praxis für die Praxis. medhochzwei Verlag GmbH, Heidelberg

    Google Scholar 

  36. Kessler J, Fengler S, Kaesberg S et al (2014) [DemTect 40- and DemTect 80+: new scoring routines for these age groups]. Fortschr Neurol Psychiatr 82:640–645

    Article  CAS  PubMed  Google Scholar 

  37. Krejczy M, Harenberg J, Marx S et al (2014) Comparison of cost-effectiveness of anticoagulation with dabigatran, rivaroxaban and apixaban in patients with non-valvular atrial fibrillation across countries. J Thromb Thrombolysis 37:507–523

    Article  PubMed  Google Scholar 

  38. Kripalani S, Yao X, Haynes RB (2007) Interventions to enhance medication adherence in chronic medical conditions: a systematic review. Arch Intern Med 167:540–550

    Article  PubMed  Google Scholar 

  39. Le Heuzey JY, Ammentorp B, Darius H et al (2014) Differences among western European countries in anticoagulation management of atrial fibrillation. Data from the PREFER IN AF registry. Thromb Haemost 111:833–841

    Article  CAS  PubMed  Google Scholar 

  40. Levey AS, Coresh J, Greene T et al (2006) Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 145:247–254

    Article  CAS  PubMed  Google Scholar 

  41. Lin HJ, Wolf PA, Kelly-Hayes M et al (1996) Stroke severity in atrial fibrillation. The Framingham Study. Stroke 27:1760–1764

    Article  CAS  PubMed  Google Scholar 

  42. Lindeman RD, Tobin J, Shock NW (1985) Longitudinal studies on the rate of decline in renal function with age. J Am Geriatr Soc 33:278–285

    Article  CAS  PubMed  Google Scholar 

  43. Lindhoff-Last E, Ansell J, Spiro T et al (2013) Laboratory testing of rivaroxaban in routine clinical practice: when, how, and which assays. Ann Med 45:423–429

    Article  CAS  PubMed  Google Scholar 

  44. Lopes RD, Crowley MJ, Shah BR et al Stroke Prevention in Atrial Fibrillation. Agency for Healthcare Research and Quality (US); August 2013. Report No.: 13-EHC113-EF. AHRQ Comparative Effectiveness Reviews. Zugegriffen: 9. Nov. 2014

  45. Lu Y, Won KA, Nelson BJ et al (2008) Characteristics of the amiodarone-warfarin interaction during long-term follow-up. Am J Health Syst Pharm 65:947–952

    Article  CAS  PubMed  Google Scholar 

  46. Mansoor SM, Krass I, Aslani P (2013) Multiprofessional interventions to improve patient adherence to cardiovascular medications. J Cardiovasc Pharmacol Ther 18:19–30

    Article  PubMed  Google Scholar 

  47. Meschia JF, Bushnell C, Boden-Albala B et al (2014 (online first)) Guidelines for the Primary Prevention of Stroke: a Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke

  48. Morrill AM, Ge D, Willett KC (2015) Dosing of target-specific oral anticoagulants in special populations. Ann Pharmacother 49:1031–1045

    Article  CAS  PubMed  Google Scholar 

  49. Mueller E, Kirch W (2009) Phenprocoumon (Marcumar®): gefährliche Interaktionen. Arzneiverordnung Praxis 36:141–143

    Google Scholar 

  50. Nabauer M, Gerth A, Limbourg T et al (2009) The Registry of the German Competence NETwork on Atrial Fibrillation: patient characteristics and initial management. Europace 11:423–434

    Article  PubMed  PubMed Central  Google Scholar 

  51. Nikolaus T, Bach M, Specht-Leible N et al (1995) The Timed Test of Money Counting: a short physical performance test for manual dexterity and cognitive capacity. Age Ageing 24:257–258

    Article  CAS  PubMed  Google Scholar 

  52. Nikolaus T, Kruse W, Bach M et al (1996) Elderly patients’ problems with medication. An in-hospital and follow-up study. Eur J Clin Pharmacol 49:255–259

    Article  CAS  PubMed  Google Scholar 

  53. Ohlmeier C, Mikolajczyk R, Haverkamp W et al (2013) Incidence, prevalence, and antithrombotic management of atrial fibrillation in elderly Germans. Europace 15:1436–1444

    Article  PubMed  Google Scholar 

  54. Oldgren J, Healey JS, Ezekowitz M et al (2014) Variations in cause and management of atrial fibrillation in a prospective registry of 15,400 emergency department patients in 46 countries: the RE-LY Atrial Fibrillation Registry. Circulation 129:1568–1576

    Article  PubMed  Google Scholar 

  55. Patel MR, Mahaffey KW, Garg J et al (2011) Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 365:883–891

    Article  CAS  PubMed  Google Scholar 

  56. Perera V, Bajorek BV, Matthews S et al (2009) The impact of frailty on the utilisation of antithrombotic therapy in older patients with atrial fibrillation. Age Ageing 38:156–162

    Article  PubMed  Google Scholar 

  57. Podsiadlo D, Richardson S (1991) The timed „Up & Go“: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142–148

    Article  CAS  PubMed  Google Scholar 

  58. Reilly PA, Lehr T, Haertter S et al (2014) The effect of dabigatran plasma concentrations and patient characteristics on the frequency of ischemic stroke and major bleeding in atrial fibrillation patients: the RE-LY Trial (Randomized Evaluation of Long-Term Anticoagulation Therapy). J Am Coll Cardiol 63:321–328

    Article  CAS  PubMed  Google Scholar 

  59. Ryan R, Santesso N, Lowe D et al (2014) Interventions to improve safe and effective medicines use by consumers: an overview of systematic reviews. Cochrane Database Syst Rev 4:CD007768

    PubMed  Google Scholar 

  60. Samama MM, Contant G, Spiro TE et al (2013) Laboratory assessment of rivaroxaban: a review. Thromb J 11:11

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Schmitz EM, Boonen K, Van Den Heuvel DJ et al (2014) Determination of dabigatran, rivaroxaban and apixaban by ultra-performance liquid chromatography – tandem mass spectrometry (UPLC-MS/MS) and coagulation assays for therapy monitoring of novel direct oral anticoagulants. J Thromb Haemost 12:1636–1646

    Article  CAS  PubMed  Google Scholar 

  62. Schwabe U, Paffrath D (2014) Arzneiverordnungs-Report 2014: Aktuelle Daten, Kosten, Trends und Kommentare. Springer Verlag, Berlin

    Book  Google Scholar 

  63. Sharma M, Cornelius VR, Patel JP et al (2015) Efficacy and harms of direct oral anticoagulants in the elderly for stroke prevention in atrial fibrillation and secondary prevention of venous thromboembolism: systematic review and meta-analysis. Circulation 132:194–204

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Shoker A, Hossain MA, Koru-Sengul T et al (2006) Performance of creatinine clearance equations on the original Cockcroft-Gault population. Clin Nephrol 66:89–97

    Article  CAS  PubMed  Google Scholar 

  65. Sommer S, Müller-Gabriel S, Kasprick L (2013) Kongressband Netzwerkkonferenz 2013 GeriNet Leipzig. www.gerinet-leipzig.de

  66. Spannagl M, Bauersachs R, Debus ES et al (2012) [Dabigatran therapy – perioperative management and interpretation of coagulation tests]. Hämostaseologie 32:294–305

    Article  CAS  PubMed  Google Scholar 

  67. Stangier J, Rathgen K, Stahle H et al (2007) The pharmacokinetics, pharmacodynamics and tolerability of dabigatran etexilate, a new oral direct thrombin inhibitor, in healthy male subjects. Br J Clin Pharmacol 64:292–303

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Stangier J, Stahle H, Rathgen K et al (2008) Pharmacokinetics and pharmacodynamics of the direct oral thrombin inhibitor dabigatran in healthy elderly subjects. Clin Pharmacokinet 47:47–59

    Article  CAS  PubMed  Google Scholar 

  69. Steering Committee of the Physicians’ Health Study Research Group (1989) Final report on the aspirin component of the ongoing Physicians’ Health Study. N Engl J Med 321:129–135

    Article  Google Scholar 

  70. Steiner T, Bohm M, Dichgans M et al (2013) Recommendations for the emergency management of complications associated with the new direct oral anticoagulants (DOACs), apixaban, dabigatran and rivaroxaban. Clin Res Cardiol 102:399–412

    Article  CAS  PubMed  Google Scholar 

  71. Tamblyn R, Eguale T, Huang A et al (2014) The incidence and determinants of primary nonadherence with prescribed medication in primary care: a cohort study. Ann Intern Med 160:441–450

    Article  PubMed  Google Scholar 

  72. Troconiz IF, Tillmann C, Liesenfeld KH et al (2007) Population pharmacokinetic analysis of the new oral thrombin inhibitor dabigatran etexilate (BIBR 1048) in patients undergoing primary elective total hip replacement surgery. J Clin Pharmacol 47:371–382

    Article  CAS  PubMed  Google Scholar 

  73. Wann LS, Curtis AB, January CT et al (2011) 2011 ACCF/AHA/HRS focused update on the management of patients with atrial fibrillation (Updating the 2006 Guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 57:223–242

    Article  PubMed  Google Scholar 

  74. Wilke T, Groth A, Mueller S et al (2013) Incidence and prevalence of atrial fibrillation: an analysis based on 8.3 million patients. Europace 15:486–493

    Article  PubMed  Google Scholar 

  75. World Health Organisation Adherence to long-term therapies: Evidence for action. Geneva, 2003. http://www.who.int/chp/knowledge/publications/adherence_full_report.pdf. Zugegriffen: 9. Nov. 2014

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Danksagungen

C. Azadi, Pfizer Pharma GmbH, Berlin, organisierte die Konferenz. Pfizer Pharma GmbH finanzierte die Konferenz und bot Unterstützung bei der Vorbereitung dieses Arbeitspapiers durch 3P Consulting, Seefeld, nahm jedoch keinen Einfluss auf die Inhalte. Alle Verfasser waren für kritische Überprüfungen des Manuskripts und für die Formulierung der zentralen Inhalte verantwortlich. Sie genehmigten die Endfassung des Manuskripts.

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  1. Institut für Biomedizin des Alterns, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, 90419, Nürnberg, Deutschland

    Philipp Bahrmann MHBA

  2. European Health Care Foundation, Zug, Schweiz

    Fred Harms

  3. Hämostatikum, München, Deutschland

    Christian Martin Schambeck

  4. Institut für Experimentelle und Klinische Pharmakologie und Toxikologie, Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität, Heidelberg, Deutschland

    Martin Wehling

  5. Allgemeinmedizinische Gemeinschaftspraxis, Leipzig, Deutschland

    Jürgen Flohr

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P. Bahrman war Stipendiat des Forschungskollegs Geriatrie der Robert Bosch Stiftung, Stuttgart. Er erhielt Vortrags- und Beratungshonorare von Pfizer, Bayer, Novartis, AstraZeneca, Boehringer-Ingelheim und ThermoScientific. J. Flohr erhielt Beratungs- und Vortragshonorare von Berlin-Chemie, Grünenthal, GSK, Hexal, Mundipharma, MSD, Pohl-Boskamp, Shire, UCB und Pfizer. M. Wehling war von 2004 bis 2006 während seines Sabbaticals von seiner Professur an der Universität Heidelberg bei AstraZeneca R&D, Mölndal, als Leiter der medizinischen Forschung (translationale Medizin) beschäftigt. Nach Rückkehr auf seine Position im Januar 2007 erhielt er Vortrags- und Beratungshonorare von Sanofi-Aventis, Novartis, Takeda, Roche, Pfizer, Bristol-Myers Squibb, Bayer, Boehringer-Ingelheim, Otsuka, Daichii-Sankyo, Lilly, LEO, Shire und Novo-Nordisk. F. Harms und C.M. Schambeck geben an, dass kein Interessenkonflikt besteht.

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Bahrmann, P., Harms, F., Schambeck, C.M. et al. Neue orale Antikoagulanzien zur Prophylaxe von Schlaganfällen. Z Gerontol Geriat 49, 216–226 (2016). https://doi.org/10.1007/s00391-016-1027-z

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