Management gastrointestinaler Blutungen unter Antikoagulation

ZUSAMMENFASSUNG

Die endoskopische Therapie bei gastrointestinalen Blutungen ist hoch effektiv und sicher, auch unter Einnahme von Antikoagulanzien. Das technische Vorgehen unterscheidet sich nicht vom Vorgehen bei fehlender Einnahme von Antikoagulanzien, wobei z. B. der Stellenwert einer primären OTSC („over-the-scope clip“, Ovesco Endoscopy)-Applikation bei Hochrisikopatienten noch untersucht werden muss. Das Management der Antikoagulation unterscheidet sich zwischen den unterschiedlichen Präparaten und der zugrundeliegenden Indikation und muss dem individuellen Risiko angepasst werden. Thrombozytenaggregationshemmer sollten maximal für die Intervention pausiert und früh wieder verabreicht werden. Das Management unter dualer Plättchenhemmung oder Triple-Therapie ist zwingend interdisziplinär abzusprechen. Bei Niedrigrisikosituation kann die duale Therapie in der Regel fortgeführt werden. Bei vitaler Blutung unter Vollantikoagulation ist eine Antagonisierung empfohlen, bei nicht vitaler Blutung ist diese abhängig vom endoskopischen Erfolg. Die Vollantikoagulation sollte frühestmöglich, in der Regel nach ca. 7 Tagen, wieder aufgenommen werden (Ausnahmen: mechanische Herzklappen, frisch implantierte Bioklappen, sehr hohes Thromboembolierisiko).

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