Individualisierte “minimal invasive” Antikoagulation unter Kontrolle von D-Dimer-Antigen-Bestimmungen

Summary

The aim of the proposed concept is to use anticoagulant therapy in prophylaxis and therapy of thromboembolic events only to an extent that the coagulation activation is just not any longer detectable. It results an individualized anticoagulation tailored to the coagulation activation of the patient (individualized “minimal invasive” anticoagulation). Intensity and control of efficiency are to be monitored by measurement of in vivo coagulation activation, e.g. by D-dimer-antigen measurement. Especially with the use of the new oral anticoagulants such a saver anticoagulant therapy – as far as possible from bleeding risk – could open up new indications, which so far are not used because of safety reasons. More patients at risk could be prevented from thromboembolic events. The proposed concept is based on pathophysiological considerations and own clinical experience. It should be evaluated for efficiency in clinical studies.

Zusammenfassung

Ziel des hier vorgeschlagenen Konzeptes ist es, zur Therapie und Prophylaxe thromboembolischer Ereignisse nur so stark zu antikoagulieren, dass die Gerinnungsaktivierung unterdrückt und gerade nicht mehr messbar ist. Es resultiert eine individuell an die Gerinnungsaktivierung des Patienten angepasste Antikoagulation (individualisierte “minimal invasive” Antikoagulation). Die Dosisintensität und Effektivitätskontrolle der Antikoagulation soll durch Messung der Gerinnungsaktivierung, z.B. D-Dimer-Bestimmung, gesteuert werden. Insbesondere mit dem Einsatz der neuen oralen Antikoagulantien könnte eine solche sichere, da möglichst weit von der Blutungsbereitschaft entfernte, Antikoagulation auch neue Therapieindikationen z. B. in der Primärprophylaxe erschließen, welche bisher aus Sicherheitsgründen nicht angewendet wurden. Mehr Risikopatienten könnten dadurch ohne gesteigerte Blutungs-gefährdung vor thromboembolischen Ereignissen bewahrt werden. Das vorgeschlagene Konzept beruht auf pathophysiologischen Überlegungen und eigenen klinischen Erfahrungen. Es sollte mittels Studien zur Wirksamkeit in der klinischen Anwendung verifiziert werden.

Keywords

D-dimer - anticoagulant therapy - coagulation activation - oral anticoagulants - monitoring

Schlüsselwörter

D-Dimer - Antikoagulation - Gerinnungsaktivierung - Vitamin-K-Antagonisten - Monitoring

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