Schlaganfallprävention mit neuen Antikoagulantien aus neurologischer Sicht – Nachweis von Wirksamkeit und Sicherheit

Der Nachweis von Wirksamkeit und Sicherheit der neuen oralen Antikoagulantien (OAK) bei Patienten mit Vorhofflimmern stellt einen Meilenstein für die Primär- und Sekundärprophylaxe von Schlaganfällen dar. Die Kenntnis der pharmakologischen Eigenschaften der Substanzen ist für die Patientenauswahl und langfristige Patientenbetreuung wesentlich. Neben der Sicherung der Patientenadhärenz bestehen aktuelle Herausforderungen aus neurologischer Sicht in der Behandlung von akuten Hirnischämien und Hirnblutungen unter neuen OAK. Insgesamt besteht die berechtigte Hoffnung, die mit Abstand wirksamste Schlaganfallpräventionstherapie – die orale Antikoagulation bei Vorhofflimmern – nunmehr tatsächlich bei der großen Mehrzahl der gefährdeten Patienten etablieren zu können.

Demonstration of efficacy and safety of new oral anticoagulants (OAC) in patients with atrial fibrillation is a milestone in primary and secondary prevention of stroke. Knowledge of the specific pharmacological properties of the drugs is essential for patient selection and long-term medical care. From the neurologist's point of view assurance of drug adherence and treatment of acute ischemic and hemorrhagic stroke under new oral anticoagulants are current challenges associated with new OAC. Nevertheless, there is a realistic perspective that the far most effective preventive stroke therapy - oral anticoagulation in atrial fibrillation – can now actually be established in the vast majority of patients at risk.

Key words

Atrial fibrillation - new oral anticoagulants - stroke prevention - drug adherence - pharmacological properties

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