Neue Antikoagulantien – Gleichwertig oder wirksamer, gleich oder besser verträglich?

Die neuen oralen Antikoagulantien Dabigatran und Rivaroxaban sind nach elektivem Knie– und Hüftgelenksersatz seit kurzem zur postoperativen Thromboembolieprophylaxe zugelassen. Dabigatran zeigte bei Patienten mit Vorhofflimmern erstmals eine bessere Wirksamkeit und Verträglichkeit als INR–adjustiertes Warfarin zur Prophylaxe zerebraler und nicht–zerebraler Embolien. Zu dieser Indikation werden die Studien mit Rivaroxaban und Apixaban im nächsten Jahr beendet.

Bei den systemisch verabreichten neuen Antikoagulantien zeigen erste Daten eine verbesserte Wirksamkeit des intravenös verabreichten direkten Faktor–Xa–Hemmers Otamixaban bei Patienten mit instabiler Angina.

Das sehr lang wirkende subkutan verabreichte Idrabiotaparinux wird bei Patienten mit Lungenembolie geprüft. Von Bedeutung ist die Neutralisierung des antikoagulanten Effektes und die Elimination der Substanz durch intravenös verabreichtes Avidin, ein Hühnereiweiß.

Initial clinical trials have shown that new oral anticoagulants yield at least equal or even more effective and at least equally or better tolerated results than INR–adjusted coumarins. So far, data have been published for Dabigatran for atrial fibrillation. Further results for Rivaroxaban and Apixaban for this will be shortly available. Initial data for the systemically applied new anticoagulants show an improved efficacy of the intravenously applied direct factor Xa inhibitor Otamixaban in patients with unstable angina pectoris.

The very long–acting subcutaneously administered Idrabiotaparinux is being tried out on pulmonary embolism patients. The neutralisation of the anticoagulant effect and the elimination of the substance by means of intravenously administered Avidin (an ovalbumin) are important.

Key words

New oral anticoagulants - coumarin - Dabigatran - Rivaroxaban - Apixaban - Otamixaban - Idrabiotaparinux - Avidin

Literatur

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