Wie antikoaguliert man ältere und fragile Patienten?

Zusammenfassung

Mit zunehmendem Alter steigt das Risiko für Thrombosen, Blutungen und Nierenfunktionsstörungen. Die Wirksamkeit und Sicherheit der direkten oralen Antikoagulanzien (DOAKs) bei fragilen Patienten (Alter 75 Jahre und/oder Kreatinin-Clearance < 50 ml/min und/oder Körpergewicht unter 50 kg) mit Indikation zur Antikoagulation ist eines der schwierigsten Themen in der aktuellen kardiovaskulären Medizin. Neue Registerdaten aus Subgruppenanalysen großer Studien und Register weisen auf die Überlegenheit von DOAKs im Vergleich mit VKA hin. In diesem Artikel werden sowohl Daten aus neuen Studien als auch Subgruppenanalysen von wegweisenden Studien ausgewertet, um neue Erkenntnisse zu gewinnen und Wege für die Antikoagulation bei fragilen Patienten zu beschreiben.

Abstract

Risks of thrombosis, bleeding and renal impairment are increasing with age. The efficacy and safety of the direct oral anticoagulants (DOACs) in fragile patients (age > 75 years and/or creatinine clearance levels < 50 ml/min and/or body weight below 50 kg) with indication for anticoagulation is one of the most challenging topic in cardiovascular medicine. New registry data from subgroup analyses of landmark studies and registries point towards to superiority of DOACs. This article summarizes new insights and describes pathways for anticoagulation in fragile patients.

Schlüsselwörter

Antikoagulation - ältere Patienten - fragil - venöse Thromboembolien - NOAK - DOAC - VHF

Key words

anticoagulation - elderly - fragile - venous thromboembolism - NOAC - DOAC - atrial fibrillation

Publikationsverlauf

Artikel online veröffentlicht:
20. Oktober 2020

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