Neue Aspekte des INR-Selbstmonitorings

Zusammenfassung

Fast jeder zweite Patient, der auf die Therapie mit Vitamin- K-Antagonisten angewiesen ist, kann nach erfolgreichem Abschluss einer standardisierten Schulung das INR-Selbstmanagement ausführen. Eine Einführung der Patientenselbsttestung in Deutschland könnte den Anteil noch erhöhen, da betagte Patienten oder deren Angehörige bzw. Mitarbeiter von Pflegediensten den INR-Wert mit telemetrischen Verfahren einem Antikoagulationszentrum übermitteln könnten. Eine sorgfältige, wöchentliche Gerinnungsselbstkontrolle führt zu einer besseren Therapiekontrolle der Langzeitantikoagulation, die zur Risikoreduktion bis zu 50% führt. Dies gilt unabhängig von der Indikation zur oralen Antikoagulation und ist auch für Patienten älter als 60 Jahre nachgewiesen. Aufgrund der geringen INR-Varianz und einer höheren Anzahl von INR-Werten im Zielbereich, ist bei Patienten mit mechanischem Aortenklappenersatz eine niedrigere Antikoagulationsintensität vertretbar. Im kommenden Jahrzehnt wird das INR-Selbstmanagement/ Selbsttestung trotz Verfügbarkeit direkter Thrombininhibitoren/Faktor-Xa-Antagonisten praktiziert werden, da diese Methode zur Therapiekontrolle die Therapieadhärenz regelhaft überprüft und Korrekturen frühzeitig ermöglicht.

Summary

Nearly every second patient, who needs an oral anticoagulation with vitamin K antagonists, is feasible to perform INR-selfmanagement after participation in a structured teaching program. Patient self-testing or measuring the INR value by relatives or nurses would increase this method of control by the aid of telemedicine systems. An accurately, weekly measurement leads to an optimal therapeutic control of anticoagulation intensity, which results in an impressive risk reduction up to 50%. This depends not on the underlying heart disease and had been demonstrated in patients older than 60 years. Due to the small INR variability and therefore a higher percentage in target range, a lower anticoagulation intensity in patients with mechanical heart valve prosthesis should be justifiable. For the next decade, INR self-management/self-testing should be the method of choice, even direct thrombin inhibitors or factor Xa antagonists would be available. An advantage of INR self-management is the control of drug adherence, which could be an unresolved problem for new anticoagulants.

Schlüsselwörter

Orale Antikoagulation - Vitamin-K-Antagonisten - INRSelbstmonitoring

Keywords

Oral anticoagulation - vitamin-K-antagonists - INR-selfmonitoring

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