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Der Klinikarzt 2013; 42(S 01): 40-46
DOI: 10.1055/s-0033-1347022
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© Georg Thieme Verlag Stuttgart · New York

Labortests und Monitoring der neuen oralen Antikoagulantien – Exakte Plasmaspiegel zu kennen, kann hilfreich sein

Coagulation assays and monitoring of NOACs – To know the level of anticoagulation may be useful in some clinical situations
Helen Mani
1   Klinikum der Johann Wolfgang Goethe Universität, Schwerpunkt Angiologie/Hämostaseologie
,
Alexander Kasper
1   Klinikum der Johann Wolfgang Goethe Universität, Schwerpunkt Angiologie/Hämostaseologie
,
Edelgard Lindhoff-Last
1   Klinikum der Johann Wolfgang Goethe Universität, Schwerpunkt Angiologie/Hämostaseologie
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Publication History

Publication Date:
30 April 2013 (online)

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Um die orale Antikoagulation zu vereinfachen und zu optimieren, sind neue Wirkstoffe entwickelt worden, die spezifisch einen einzelnen Gerinnungsfaktor hemmen. Der direkte Thrombininhibitor Dabigatran sowie die direkten Faktor-Xa-Hemmer Rivaroxaban und Apixaban sind die ersten Vertreter dieser neuen Generation von Antikoagulantien, die aufgrund ihrer vorhersehbaren pharmakokinetischen und -dynamischen Eigenschaften eine routinemäßige Überwachung der Patienten nicht mehr dringend notwendig machen. Im klinischen Alltag gibt es jedoch einige Situationen, in denen es von Nutzen sein könnte, den aktuellen Antikoagulationsgrad durch die neuen oralen Antikoagulantien (NOAK) zu kennen. Inzwischen sind mehrere laborchemische Studien durchgeführt worden, um die Einflüsse dieser neuen Wirkstoffe auf die unterschiedlichen Gerinnungstests zu beschreiben. Darüber hinaus wurden kommerziell verfügbare Testsysteme entwickelt, die zur exakten Konzentrationsbestimmung der neuen oralen Antikoagulantien in klinischen Laboratorien verwendet werden können.

With the objective to simplify and optimize oral anticoagulation, new drugs have been developed, that are directly inhibiting one specific coagulation factor. The direct thrombin-inhibitor dabigatran and the direct factor-Xa-inhibitors rivaroxaban and apixaban are the first representatives of a new generation of anticoagulants, where routine monitoring is not recommended due to their predictable pharmacokinetic and pharmacodynamic profiles. Now in clinical routine settings, it has been realized, that there are several situations where it may be of assistance to assess the level of anticoagulation of NOACs. Investigations regarding the effects of NOACs on different coagulation assays have been performed in several studies followed by recommendations how to monitor the therapy by NOACs.

Key Words

Dabigatran - rivaroxaban - apixaban - level of anticoagulation - monitoring
 

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