Spezifische Antidote für nicht Vitamin-K-abhängige orale Antikoagulanzien – Aktueller Entwicklungsstand

Orale Antikoagulanzien sind für die Schlaganfallprävention bei Vorhofflimmern sowie die Therapie und Prophylaxe venöser Thromboembolien unverzichtbar. In den letzten Jahren ist mit den nicht Vitamin-K-abhängigen oralen Antikoagulanzien (NOAKs) eine Wirkstoffgruppe in den Vordergrund gerückt, die hinsichtlich ihrer Wirksamkeit und Sicherheit gegenüber den klassischen Antikoagulanzien, wie Vitamin-K-Antagonisten, relevante Vorteile bietet. Blutungskomplikationen gehören jedoch nach wie vor zu den möglichen Nebenwirkungen. Mit der Entwicklung NOAK-spezifischer Antidote wird nun ein weiterer Fortschritt in der Sicherheit der antithrombotischen Therapie erzielt: Mit Idarucizumab ist bereits ein spezifisch und rasch wirksames Antidot gegen den direkten Thrombininhibitor Dabigatran auf dem Markt verfügbar. Zur Wirkungsaufhebung der Faktor-Xa-Inhibitoren ist Andexanet alfa in Phase III der klinischen Entwicklung.

Oral anticoagulants have become indispensable for the prevention of stroke in patients with atrial fibrillation and the therapy and prevention of venous thromboembolism. Over the past years, the group of NOAC came to the fore, which bears several advantages compared to conventional vitamin k antagonists. Nevertheless, bleeding complications are a possible side effect of these therapeutic agents. The development of NOAC specific antidotes can potentially improve safety in antithrombotic therapy. Idarucizumab, an antidote specifically designed for the reversal of the direct thrombin inhibitor dabigatran already underwent approval and was brought to the market. A reversal agent for factor Xa anticoagulants, andexanet alfa, is currently under clinical investigation (phase III).

Key Words

Idarucizumab - NOAC - antidot - Andexanet alfa - Dabigatran - Faktor Xa

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