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Der Klinikarzt 2018; 47(03): 86-94
DOI: 10.1055/a-0575-1650
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© Georg Thieme Verlag Stuttgart · New York

Thrombose, Lungenembolie und Antikoagulation

Wie und wie lange antikoagulieren?
Tobias Geisler
Medizinische Klinik III, Abteilung für Kardiologie und Kreislauferkrankungen, Tübingen
,
Fabian Stimpfle
Medizinische Klinik III, Abteilung für Kardiologie und Kreislauferkrankungen, Tübingen
› Author Affiliations
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Publication History

Publication Date:
29 March 2018 (online)

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Zusammenfassung

Häufigste Ursache einer Lungenarterienembolie (LAE) ist eine venöse Thromboembolie in Folge einer tiefen Beinvenenthrombose (TBVT). Entsprechend der aktuellen Leitlinien, ist bei TVBT oder LAE eine Antikoagulation für mindestens 3 Monate indiziert. In der initialen Phase nach Diagnosestellung kommen hierfür weiterhin hauptsächlich Heparine zum Einsatz. In der Sekundärprävention werden Vitamin-K-Antagonisten (VKA) zunehmend durch die Nicht-Vitamin-K-Antagonisten oralen Antikoagulanzien (NOAK) abgelöst. Vorteilhafte Eigenschaften der NOAKs im Vergleich zu VKA sind insbesondere das günstigere Sicherheitsprofil bezüglich Blutungsereignisse aber auch eine weniger variable Pharmakokinetik und der schnelle Wirkungseintritt. Ob nach der akuten Phase zur Prävention eines Rezidivs die Dauer der Antikoagulation verlängert werden soll, ist vor dem Hintergrund des individuellen Rezidiv- und Blutungsrisikos abzuwägen.

 

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