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Kardiologie up2date 2014; 10(01): 47-59
DOI: 10.1055/s-0034-1365058
Herzinsuffizienz
© Georg Thieme Verlag KG Stuttgart · New York

Antikoagulation bei Herzinsuffizienz

Gregor Simonis
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Publication Date:
17 March 2014 (online)

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Abstract

Heart failure is a complex of symptoms caused by various etiologies, basically characterized by reduced blood flow, changes in blood composition, and the activation of the endothelium. This leads to a pro-thrombotic state in many patients. Despite this clear-cut pathophysiology, the evidence for anticoagulation treatment of patients with heart failure is limited. Patients with heart failure and any form of atrial fibrillation have clearly to be treated with plasmatic anticoagulants. However, in patients with sinus rhythm, plasmatic anticoagulants were not more effective than aspirin in terms of survival. Thus, the decision whether to anticoagulate patients with heart failure should be made depending on the individual risk-to-benefit-ratio.

Kernaussagen

  • Thromboembolische Komplikationen tragen zu Morbidität und Mortalität von Herzinsuffizienzpatienten bei.

  • Bei Herzinsuffizienzpatienten sollte aktiv nach Indikationen für die Antikoagulation, vor allem nach paroxysmalem Vorhofflimmern, gesucht werden. Eine Risikoabschätzung für die Antikoagulation ist mit dem CHA2DS2VASc- und dem HASBLED-Score möglich [3].

  • Wenn eine plasmatische Antikoagulation durchgeführt wird, ist eine parallele Gabe von Thrombozytenaggregationshemmern nicht sinnvoll (außer 12 Monate nach Myokardinfarkt).

  • Wenn keine spezifische Indikation (KHK etc.) besteht, ist ASS bei Herzinsuffizienz nicht indiziert.

  • Aktuell gibt es keine gute Datenlage dafür, alle Herzinsuffizienzpatienten mit plasmatischer Antikoagulation zu behandeln. Individuelle Antikoagulationsentscheidungen sind nach Abwägung von Thromboembolierisiko und Blutungsrisiko gemeinsam mit dem Patienten zu treffen.

 

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