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Der Klinikarzt 2009; 38(7/08): 344-350
DOI: 10.1055/s-0029-1240511
Schwerpunkt

© Georg Thieme Verlag Stuttgart · New York

Antithrombotische Therapie bei Patienten mit Herzklappenfehlern prä– und postoperativ – Standards und Tipps

Antithrombotic therapy in patients with valvular defects – Pre– and postoperative standards and tipsCornelia Piper1 , Dieter Horstkotte1
  • 1Kardiologische Klinik, Herz– und Diabeteszentrum NRW Bad Oeynhausen, Ruhr–Universität Bochum
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Publication History

Publication Date:
28 August 2009 (online)

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Das Risiko von Blutungen und Thromboembolien unter Dauerantikoagulation ist weitgehend von der Stabilität der Gerinnungshemmung abhängig, solange ein therapeutischer Korridor von INR 2,0–3,5 eingehalten wird. Als Antithrombotika werden Vitamin–K–Antagonisten, unfraktionierte Heparine (UFH), niedermolekulare Heparine (NMH), Thrombozytenaggregationshemmer (ASS oder Clopidogrel) sowie als neue Substanzen direkte Thrombininhibitoren und Faktor–Xa–Antagonisten eingesetzt. Bei zahlreichen angeborenen und erworbenen Herzfehlern besteht aufgrund von Schädigungen des endokardialen Endothels ein deutlich erhöhtes Risiko der intrakardialen Thrombusbildung und ihrer Embolisation, weshalb eine orale Dauerantikoagulation in vielen Fällen zweckmäßig ist. Mechanische Herzklappenprothesen sind thrombogen und erfordern eine dauerhafte Antikoagulation. Klappenrekonstruktionen unter Verwendung von Dacronringen sind wie Patienten mit Bioprothesen zu behandeln. Jede abrupte Änderung des INR–Wertes sollte vermieden werden, da hierunter das Blutungs– bzw. Thromboembolierisiko signifikant ansteigt. Die Wahl des Antikoagulanz in der Schwangerschaft muss individuell unter Beachtung aller mütterlichen und fetalen Komplikationen erfolgen.

The risk of hemorrhages and thromboembolisms during permanent anticoagulation depends largely on the stability of the anticoagulation as long as a therapeutic „corridor” of INR 2,0–3,5 is maintained. Antithrombotics employed are oral anticoagulants, non–fractionated heparins, low–molecular weight heparins, platelet aggregation inhibitors (ASA or Clopidogrel) as well as new substances such as direct thrombin inhibitors and Xa antagonists. In many cases of congenital or acquired cardiac defects there is a distinctly increased risk of intracardial thrombus formation and embolization of thrombi due to a damaged endocardial endothelium. This often requires permanent oral coagulation recommendable. For example, mechanical prosthetic heart valves are thrombogenic, requiring permanent anticoagulation. Valve reconstructions with Dacron rings should be handled like patients with bioprostheses. Avoid any abrupt changes of the INR value since this significantly increases the risk of thromboembolism. The choice of the anticoagulant during pregnancy must be individual taking into account all possible maternal and fetal complications.

Key words

Antithrombotics - bleeding complications - inhibition of coagulation - embolization - valvular defects

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Korrespondenz

PD Dr. med. Cornelia Piper

Kardiologische Klinik Herz– und Diabeteszentrum NRW Ruhr–Universität Bochum

Georgstraße 11

32545 Bad Oeynhausen

Fax: Fax: 05731/97-2194

Email: cpiper@hdz-nrw.de

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