Antikoagulanzientherapie im hohen Lebensalter – Was ist zu beachten?

Die Entscheidung, eine orale Antikoagulation bei Vorhofflimmer-Patienten im hohen Lebensalter durchzuführen, fällt häufig schwer, da nicht nur das Thrombembolie-Risiko sondern auch das Blutungs-Risiko erhöht ist. Trotz klarer Indikation werden viele dieser älteren Patienten nicht oral antikoaguliert, da Blutungskomplikationen befürchtet werden. Aktuelle Studiendaten zeigen aber, dass bei adäquater Therapie mit Vitamin-K-Antagonisten oder mit an Alter und Nierenfunktion angepasster Dosis der direkten oralen Antikoagulanzien der klinische Nutzen einer oralen Antikoagulation höher ist als das Risiko schwerer Komplikationen.

The decision to initiate oral anticoagulation in elderly atrial fibrillation patients is often difficult, because not only the thromboembolic risk but also the bleeding risk is high in these patients. In spite of a clear indication many of these patients are not orally anticoagulated due to worries about bleeding complications. However, recent studies indicate that on adequate therapy with vitamin K antagonists or direct oral anticoagulants that are adjusted to age and renal function the clinical benefit of an oral anticoagulation is higher than the risk of major complications.

Key words

Atrial fibrillation - anticoagulation - direct oral anticoagulants - vitamin K antagonists - elderly adults

• Literatur

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