Neue Antikoagulanzien für die Thromboembolieprophylaxe bei Vorhofflimmern

Zusammenfassung

Vorhofflimmern ist die häufigste Herzrhythmusstörung und Hauptursache für kardioembolische Schlaganfälle. Die Thromboembolieprophylaxe erfolgt in Abhängigkeit des individuellen Risikos mit Acetylsalicylsäure (ASS) oder Vitamin-K-Antagonisten. Die Effektivität und Sicherheit der oralen Antikoagulation wird durch eine enge therapeutische Breite und inter- und intraindividuellen Schwankungen des INR-Wertes aufgrund genetischer Dispositionen sowie alimentärer Einflüsse, Dosierungsfehler, zu seltene INR-Kontrolle und Arzneimittelinteraktionen beträchtlich limitiert. Neue, oral verfügbare Substanzen mit unterschiedlichen Wirkmechanismen stellen vielversprechende Therapiealternativen dar. In dieser Arbeit werden die Faktor-Xa-Inhibitoren Apixaban, Rivaroxaban, der direkte Thrombininhibitor Dabigatranetexilat mit ihren korrespondierenden Phase-III-Studien (ARISTOTLE, ROCKET-AF, RE-LY) bei Patienten mit Vorhofflimmern näher erläutert und das Studiendesign und – soweit verfügbar – auch die Studienergebnisse verglichen.

Abstract

The most frequent cardiac arrhythmia and main cause for cardio-embolic stroke is atrial fibrillation. Prophylaxis for thrombembolic events is performed regarding individual risk of patients with either ASS or vitamin-K-antagonists. Efficacy and safety of oral anticoagulation is limited by a narrow therapeutical range as well as by inter- and intraindividual variability of INR-values due to genetic disposition, differences in alimentation, dosage errors, rare control of INR-levels and drug-interactions. New oral anticoagulants with different mechanisms of action may be a promising therapeutic option in future. This review addresses the new anticoagulants Apixaban, Rivaroxban and Dabigatranetexilat with the design and as available the results of the corresponding phase-III-trials in atrial fibrillation (ARISTOTLE, ROCKET-AF, RE-LY).

Schlüsselwörter

Dabigatran - Rivaroxaban - Apixaban - orale Antikoagulation - Vorhofflimmern

Keywords

dabigatran - rivaroxaban - apixaban - oral anticoagulation - atrial fibrillation

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