Thrombose, Lungenembolie und Antikoagulation

Tobias Geisler; Fabian Stimpfle

doi:10.1055/a-0575-1650

Der Klinikarzt, Table of Contents

Der Klinikarzt 2018; 47(03): 86-94
DOI: 10.1055/a-0575-1650

Serie

Thrombose, Lungenembolie und Antikoagulation

Wie und wie lange antikoagulieren?

Authors

Tobias Geisler

Medizinische Klinik III, Abteilung für Kardiologie und Kreislauferkrankungen, Tübingen
Fabian Stimpfle

Medizinische Klinik III, Abteilung für Kardiologie und Kreislauferkrankungen, Tübingen

Abstract

Zusammenfassung

Häufigste Ursache einer Lungenarterienembolie (LAE) ist eine venöse Thromboembolie in Folge einer tiefen Beinvenenthrombose (TBVT). Entsprechend der aktuellen Leitlinien, ist bei TVBT oder LAE eine Antikoagulation für mindestens 3 Monate indiziert. In der initialen Phase nach Diagnosestellung kommen hierfür weiterhin hauptsächlich Heparine zum Einsatz. In der Sekundärprävention werden Vitamin-K-Antagonisten (VKA) zunehmend durch die Nicht-Vitamin-K-Antagonisten oralen Antikoagulanzien (NOAK) abgelöst. Vorteilhafte Eigenschaften der NOAKs im Vergleich zu VKA sind insbesondere das günstigere Sicherheitsprofil bezüglich Blutungsereignisse aber auch eine weniger variable Pharmakokinetik und der schnelle Wirkungseintritt. Ob nach der akuten Phase zur Prävention eines Rezidivs die Dauer der Antikoagulation verlängert werden soll, ist vor dem Hintergrund des individuellen Rezidiv- und Blutungsrisikos abzuwägen.

Full Text

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