Neueste Daten und praktische Erfahrungen mit neuen oralen Antikoagulantien (NOAK) – Welche Patientenkollektive profitieren besonders?

Der Einzug der neuen oralen Antikoagulantien (NOAK) in die Klinikroutine hat die Betreuung vieler Patienten bereits heute verbessert. Mittlerweile kann man auf eine mehrjährige Erfahrung mit diesen Substanzen zurückblicken, und es haben sich Patientenkollektive herauskristallisiert, die besonders von einer NOAK-Therapie zu profitieren scheinen. Patienten mit nicht valvulärem Vorhofflimmern und erhöhtem Embolierisiko können heute neben Phenprocoumon alternativ mit Dabigatran, Rivaroxaban und Apixaban behandelt werden, Patienten mit tiefer Venenthrombose oder Lungenembolie mit Rivaroxaban. Insbesondere blutungsgefährdete Patienten ziehen derzeit häufig eine Behandlung mit einem neuen oralen Antikoagulans der aufwendigeren und oft riskanteren Phenprocoumontherapie vor. Erste Anwendungsbeobachtungen unterstreichen die Wirksamkeit und die Sicherheit der neuen Antikoagulantien bei Patienten mit Vorhofflimmern. In Zukunft werden langfristige Registerdaten weitere „Real-World“-Daten liefern, aber einen direkten (prospektiven und randomisierten) Vergleich der Wirkstoffe der neuen Substanzklasse untereinander gibt es nicht.

New oral anticoagulants (NOAC) havAEved routine clinical management of many patients. Several years of NOAC use and a variety of studies have helped to identify patients who benefit from these drugs. In Europe, dabigatran, rivaroxaban, and apixaban have been approved for stroke prevention in patients with non-valvular atrial fibrillation at high risk for embolization and can now be used as an alternative to vitamin K antagonists. Rivaroxaban has also been approved for the treatment of patients with venous thromboembolism. Clinical practice has shown that patients with vitamin K antagonist-associated bleeding complications or those who are at high risk for bleeding often prefer NOACs. First real-world data from registry analyses underline the efficacy and safety of NOACs. To date, a direct (prospectively randomized) comparison of NOACs is not available.

Key words

new oral anticoagulants - dabigatran - rivaroxaban - apixaban - edoxaban

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