Anticoagulants

Summary

Anticoagulants are effective in the prevention and treatment of a variety of arterial and venous thrombotic disorders but are associated with an increased risk of serious bleeding complications. Based on well documented studies of patients using vitamin K antagonists the incidence of major bleeding is 0.5%/year and the incidence of intracranial bleeding is 0.2%/year, however, in real life practice this incidence may be even higher. Risk factors for bleeding are the intensity of anticoagulation, the management strategy to keep the anticoagulant effect in the desired range, and patient characteristics. Recently, a new generation of anticoagulants have been developed and is currently evaluated in clinical trials. Initial results show a similar or superior efficacy over conventional anticoagulant agents with a good safety profile. In case of serious bleeding complications in a patient who uses vitamin K antagonists, this anticoagulant treatment can be quickly reversed by administration of vitamin K or coagulation factor concentrates. For the newer anticoagulants, quick reversal strategies are more cumbersome, although some interventions, including prothrombin complex concentrates, show promising results in initial experimental studies.

Zusammenfassung

Antikoagulanzien sind bei verschiedenen arteriellen und venösen thrombotischen Störungen in der Prävention und Behandlung wirksam, gehen aber mit einem erhöhten Risiko für ernsthafte Blutungskomplikationen einher. Gut dokumentierten Studien an Patienten unter Vitamin-K-Antagonisten zufolge liegt die Inzidenz großer Blutungen bei 0,5%/Jahr und die intrakranieller Blutungen bei 0,2%/Jahr. Doch diese Inzidenz kann in der täglichen Praxis noch höher sein. Risikofaktoren für Blutungen sind: Intensität der Antikoagulation, Behandlungsstrategie zur Optimierung des gerinnungshemmenden Effekts und Patientencharakteristika. Inzwischen wurde eine neue Generation von Antikoagulanzien entwickelt, die zurzeit in klinischen Studien untersucht wird. Erste Ergebnisse zeigen eine ähnliche oder überlegene Wirksamkeit wie bei konventionellen Antikoagulanzien und ein gutes Sicherheitsprofil. Bei Ernst- haften Blutungskomplikationen kann diese gerinnungshemmende Therapie bei einem Patienten unter Vitamin-K-Antagonisten rasch durch Vitamin K oder Konzentrate aus Gerinnungsfaktoren umgekehrt werden. Bei den neuen Antikoagulanzien sind solche Umkehrstrategien schwieriger, obgleich einige Interventionen, u. a. Prothrombinkomplex-Konzentrate, in experimentellen Studien viel versprechende Resultate zeigten.

Keywords

Anticoagulants - vitamin K antagonists - heparin - pentasaccharide - dabigatran - rivaroxaban

Schlüsselwörter

Antikoagulanzien - Vitamin-K-Antagonisten - Heparin - Pentasaccharide - Dabigatran - Rivaroxaban

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