Skip to main content
SpringerLink
Log in

Antikoagulation bei Vorhofflimmern: Neue Antikoagulanzien

Anticoagulation for atrial defibrillation: new anticoagulants

  • Klinische Pharmakologie
  • Published:
Der Kardiologe Aims and scope

Zusammenfassung

Vorhofflimmern ist eine der häufigsten Indikationen zur Antikoagulation in der Kardiologie. Die bisherige Standardbehandlung bestand in der Gabe von Vitamin-K-Antagonisten bei Patienten mit zusätzlichen Risikofaktoren. Neue, oral verfügbare Antikoagulanzien sind direkte Antagonisten von Faktor Xa (Rivaroxaban, Apixaban) oder Faktor IIa (Dabigatran). Diese neue Generation gerinnungsaktiver Substanzen erfordert keine Wirksamkeitskontrollen mehr und hat im Vergleich zu Phenprocoumon kurze Halbwertzeiten (ca. 12 h). In großen randomisierten Studien zeigten die neuen Antikoagulanzien ein überlegenes Nutzen-Risiko-Profil im Vergleich zur Therapie mit Vitamin-K-Antagonisten. Besonders hervorzuheben ist eine deutlich reduzierte Rate intrakranieller Blutungen. Nachdem für Dabigatran und Rivaroxaban eine Zulassung für diese Indikation vorliegt, werden die neuen Antikoagulanzien zunehmend zum klinischen Einsatz kommen.

Abstract

Atrial fibrillation is one of the most frequent indications for oral anticoagulation. In the past standard therapy consisted of the use of vitamin K antagonists in patients with additional risk factors. New oral anticoagulants are direct antagonists of factor Xa (apixaban, rivaroxaban) or factor IIa (dabigatran). These new generation anticoagulants do not require control of anticoagulant activity and the half-life is much shorter than that of phenprocoumon. Large randomized trials have demonstrated a superior risk-benefit ratio compared with vitamin k antagonists. In particular the rates of intracranial hemorrhage are greatly reduced. Now that dabigatran and rivaroxaban have been approved for prophylaxis of thromboembolic events in patients with atrial fibrillation these new anticoagulants will be increasingly used in every day practice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Ansell J, Hirsh J, Hylek E et al (2008) Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians evidence-based clinical practice guidelines (8th edn). Chest 133:160–198

    Article  Google Scholar 

  2. Banerjee A, Lane DA, Torp-Pedersen C et al (2011) Net clinical benefit of new oral anticoagulants (dabigatran, rivaroxaban, apixaban) versus no treatment in a „real world“ atrial fibrillation population: a modelling analysis based on a nationwide cohort study. Thromb Haemost 107. doi: 11-11-0784 [pii]10.1160/TH11-11-0784

  3. 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). Europace 12:1360–1420

    Article  PubMed  Google Scholar 

  4. Antithrombotic Trialist’s Collaboration (2002) Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ (Clinical research ed) 324:71–86

    Google Scholar 

  5. Connolly S, Pogue J, Hart R et al (2006) Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the atrial fibrillation clopidogrel trial with irbesartan for prevention of vascular events (ACTIVE W): a randomised controlled trial. Lancet 367:1903–1912

    Article  PubMed  CAS  Google Scholar 

  6. Connolly SJ, Ezekowitz MD, Yusuf S et al (2009) Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 361:1139–1151

    Article  PubMed  CAS  Google Scholar 

  7. Connolly SJ, Ezekowitz MD, Yusuf S et al (2010) Newly identified events in the RE-LY trial. N Engl J Med 363:1875–1876

    Article  PubMed  CAS  Google Scholar 

  8. Connolly SJ, Pogue J, Hart RG et al (2009) Effect of clopidogrel added to aspirin in patients with atrial fibrillation. N Engl J Med 360:2066–2078

    Article  PubMed  Google Scholar 

  9. Diener HC, Connolly SJ, Ezekowitz MD et al (2010) Dabigatran compared with warfarin in patients with atrial fibrillation and previous transient ischaemic attack or stroke: a subgroup analysis of the RE-LY trial. Lancet Neurol 9:1157–1163. doi: S1474-4422(10)70274-X [pii]10.1016/S1474-4422(10)70274-X

    Article  PubMed  CAS  Google Scholar 

  10. Eikelboom JW, Wallentin L, Connolly SJ et al (2011) Risk of bleeding with 2 doses of dabigatran compared with warfarin in older and younger patients with atrial fibrillation: an analysis of the randomized evaluation of long-term anticoagulant therapy (RE-LY) trial. Circulation 123:2363–2372. doi: CIRCULATIONAHA.110.004747 [pii]10.1161/CIRCULATIONAHA.110.004747

    Article  PubMed  CAS  Google Scholar 

  11. Eriksson BI, Dahl OE, Rosencher N et al (2007) Dabigatran etexilate versus enoxaparin for prevention of venous thromboembolism after total hip replacement: a randomised, double-blind, non-inferiority trial. Lancet 370:949–956

    Article  PubMed  CAS  Google Scholar 

  12. Granger CB, Alexander JH, McMurray JJ et al (2011) Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med (online publication 28. August)

  13. Lip GY, Hart RG, Conway DS (2002) Antithrombotic therapy for atrial fibrillation. BMJ (Clinical research ed 2002) 325:1022–1025

    Google Scholar 

  14. Mant J, Hobbs FD, Fletcher K et al (2007) Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial. Lancet 370:493–503. doi: S0140-6736(07)61233-1 [pii]10.1016/S0140-6736(07)61233-1

    Article  PubMed  CAS  Google Scholar 

  15. Nagarakanti R, Ezekowitz MD, Oldgren J et al (2011) Dabigatran versus warfarin in patients with atrial fibrillation: an analysis of patients undergoing cardioversion. Circulation 123:131–136. doi: CIRCULATIONAHA.110.977546 [pii]10.1161/CIRCULATIONAHA.110.977546

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  17. Wallentin L, Yusuf S, Ezekowitz MD et al (2010) Efficacy and safety of dabigatran compared with warfarin at different levels of international normalised ratio control for stroke prevention in atrial fibrillation: an analysis of the RE-LY trial. Lancet 376:975–983. doi: S0140-6736(10)61194-4 [pii]10.1016/S0140-6736(10)61194-4

    Article  PubMed  CAS  Google Scholar 

  18. Wieloch M, Själander A, Frykman V et al (2011) Anticoagulation control in Sweden: report of time in therapeutic range, major bleeding, and thrombo-embolic complications from the national quality registry AuriculA. Eur Heart J 32(18):2282–2289

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor weist für sich und seinen Koautor auf folgende Beziehungen hin: M.M. Vortragshonorare Glaxo Smith Kline, Lilly, Boehringer Ingelheim, Pfizer, Bayer Healthcare; Beraterhonorare Astra Zeneca, Bayer Healthcare, Boehringer Ingelheim, Daiichi Sankyo, The Medicines Company. C.B. Forschungmittel REGADO, Merck, Sanofi-Aventis, Bayer, GlaxoSmithKline, Astellas; Vortragshonorare Bristol-Myers-Squibb/Pfizer, Daiichi-Sankyo, Boehringer Ingelheim, Sanofi-Aventis, Novartis, AstraZeneca, Lilly; Beraterhonorare: Merck, Bayer Healthcare, Boehringer Ingelheim, Sanofi-Aventis.

Author information

Authors and Affiliations

  1. Innere Medizin III (Kardiologie und Angiologie), Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland

    M. Moser &  C. Bode

Authors
  1. M. Moser
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Bode
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Bode.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Moser, M., Bode, C. Antikoagulation bei Vorhofflimmern: Neue Antikoagulanzien. Kardiologe 6, 148–156 (2012). https://doi.org/10.1007/s12181-012-0406-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12181-012-0406-y

Schlüsselwörter

Keywords

Search

Navigation