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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Dr. Magnus Baumhäkel
Klinik für Innere Medizin III
Universitätsklinikum
des Saarlandes
66421 Homburg/Saar
Phone: 06841/1623289
Fax: 06841/1623446
Email: magnus@baumhaekel.de
