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Fortschr Neurol Psychiatr 2018; 86(02): 117-124
DOI: 10.1055/s-0043-118845
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Neue orale Antikoagulantien (NOAK) in der Schlaganfall-Therapie

New oral anticoagulants (NOAC) in stroke treatment
Clemens Küpper
1   Klinik und Poliklinik für Neurologie, Klinikum der Universität München, Campus Großhadern, Ludwig-Maximilians-Universität LMU München
,
Lars Kellert
1   Klinik und Poliklinik für Neurologie, Klinikum der Universität München, Campus Großhadern, Ludwig-Maximilians-Universität LMU München
2   Neurologische Klinik, Universitätsklinikum Heidelberg, Deutschland
,
Steffen Tiedt
1   Klinik und Poliklinik für Neurologie, Klinikum der Universität München, Campus Großhadern, Ludwig-Maximilians-Universität LMU München
3   Institut für Schlaganfall- und Demenzforschung (ISD), Klinikum der Universität München, Campus Großhadern, Ludwig-Maximilians-Universität LMU München
,
Frank Arne Wollenweber
1   Klinik und Poliklinik für Neurologie, Klinikum der Universität München, Campus Großhadern, Ludwig-Maximilians-Universität LMU München
3   Institut für Schlaganfall- und Demenzforschung (ISD), Klinikum der Universität München, Campus Großhadern, Ludwig-Maximilians-Universität LMU München
› Author Affiliations
Further Information

Publication History

05/15/2017

08/22/2017

Publication Date:
08 November 2017 (online)

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Zusammenfassung

Zur Prophylaxe des kardioembolischen Schlaganfalls stehen neben Vitamin K-Antagonisten in Deutschland seit 2011 die sogenannten neuen oralen Antikoagulantien (NOAK) zur Verfügung. Eine Zulassung besteht für nicht-valvuläres Vorhofflimmern. Obwohl in Deutschland eine intensive Kontroverse zu diesem Thema geführt wird, wird das Nutzen-Risiko-Verhältnis der NOAK im Vergleich zu Vitamin K-Antagonisten von den neurologischen und kardiologischen Fachgesellschaften als günstiger bewertet. Dieser Effekt wird insbesondere durch die Risikoreduktion für intrazerebrale Blutungen vermittelt. Ein spezifisches Antidot steht für Dabigatran zur Verfügung und ist für die Faktor Xa-Inhibitoren in der klinischen Prüfung. Aus Mangel an direkten Vergleichsstudien kann keines der NOAK dem anderen als überlegen angesehen werden. Die Auswahl eines NOAK sollte sich daher unter Berücksichtigung der Ergebnisse der Zulassungsstudien an praktischen Aspekten und Komorbiditäten des einzelnen Patienten orientieren.

Abstract

Since 2011, new oral anticoagulants (NOAC) can be prescribed for prevention of cardio-embolic ischemic strokes in addition to vitamin K antagonists. NOAC are indicated in patients with non-valvular atrial fibrillation. Although its use is a matter of debate in Germany, the neurological and cardiological societies recommend the use of NOAC over and above vitamin K antagonists due to a better benefit-to-risk ratio attributed to it, especially because of the lower risk of intracranial hemorrhage in NOAC use. A specific antidote is commercially available for the direct thrombin inhibitor dabigatran only. For the factor Xa inhibitors, an antidote is being investigated in clinical trials. To our best knowledge, there are no direct head-to-head studies between the NOACs. Therefore, none of them can be assumed to be superior and the decision for a specific NOAC should be based on the available scientific data from the NOAC trials considering the individual patient’s characteristics and comorbidities.

Schlüsselwörter

Schlaganfall - NOAK - Vorhofflimmern

Key words

stroke - NOAC - atrial fibrillation
 

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