Einsatz direkter oraler Antikoagulanzien bei alten Patienten

Zusammenfassung

Auch für das höhere und hohe Lebensalter sind die gleiche bis teilweise überlegene Wirksamkeit und die gleiche bis höhere Sicherheit der direkten oralen Antikoagulanzien (DOAK) gegenüber den Vitamin K-Antagonisten (VKA) durch Studiendaten gut belegt. Gerade im Hinblick auf die oft bei geriatrischen Patienten bestehende Multimedikation bieten die DOAK Vorteile bezüglich Interaktionspotenzial, Dosierschemata sowie insbesondere intrakraniellen Blutungskomplikationen. Trotzdem sind noch weitere Studien für diese Patientengruppe speziell für das Blutungsrisiko erforderlich. Beim Einsatz der DOAK sind gerade beim geriatrischen Patienten besondere klinische Situationen zu beachten (z. B. Niereninsuffizienz, rasche Dehydrierung, Demenz, Visusminderung), um Blutungskomplikationen zu vermeiden. Regelhafte klinische und laborchemische Kontrollen sind im Sinne der Therapiesicherheit obligat. Auch in der Geriatrie wird es berechtigterweise zu einer Zunahme der Einstellungen auf DOAK kommen.

Abstract

Equal safety and efficacy of direct oral anticoagulants as compared to vitamin K antagonists have been shown in elderly and very old patients. The use of these seem to have certain advantages in this special patient cohort: higher drug safety, no need for lab monitoring, less drug-drug interactions and a lower rate of intracranial hemorrhages. However, more data is needed to quantify the exact bleeding risk for geriatric patients. Elderly patients suffer quite frequently from significant comorbidities, such as renal failure, dementia, vision loss etc., which might put them at higher risk to suffer from medication side effects, especially bleeding complications. Routine clinical examinations combined with monitoring of renal function are therefore of paramount importance. Regarding these precautions the use of the new oral anticoagulants in the elderly is hence quite justified and rising.

Schlüsselwörter

direkte orale Antikoagulanzien - Geriatrie - Therapiesicherheit

Keywords

direct oral anticoagulants - elderly - safety

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