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Lege artis - Das Magazin zur ärztlichen Weiterbildung 2016; 6(04): 242-249
DOI: 10.1055/s-0041-107852
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© Georg Thieme Verlag Stuttgart · New York

Non-Vitamin-K-Antagonisten – Was ist in der klinischen Praxis zu beachten?

Boris Nohe
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Publication History

Publication Date:
16 September 2016 (online)

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Abstract

Non-Vitamin-K-Antagonisten (NOAK) werden in fixer Dosis gegeben und weisen ein günstigeres Nutzen-/Risikoverhältnis auf als Vitamin-K-Antagonisten (VKA). Um die Dosis ggf. anpassen zu können, muss die Nierenfunktion regelmäßig kontrolliert werden. Gerinnungstests sind schwer zu beurteilen und nur selten indiziert. Im Blutungsfall kann die Gerinnung unspezifisch durch Faktorenkonzentrate gebessert werden. Ein spezifisches Antidot ist bislang nur für Dabigatran verfügbar. Vor Operationen sollten NOAKs für mind. 24-48 h pausiert werden.

Kernaussagen

  • Non-Vitamin-K-Antagonisten (NOAK) besitzen ein günstigeres Nutzen-Risikoverhältnis als Vitamin-K-Antagonisten (VKA).

  • Störungen der Nierenfunktion, hohes Alter und bestimmte Begleitmedikamente können trotz ansonsten fixer Dosierung eine Dosisreduktion erfordern.

  • Vor invasiven Interventionen sind die empfohlenen Pausen einzuhalten.

  • Im Blutungsfall kann man Idarucizumab (bei Dabigatran) oder Faktorenkonzentrate (bei Dabigatran und Xa-Inhibitoren) geben.

Schlüsselwörter:

Non-Vitamin-K-Antagonisten - NOAK - Nutzen-/Risikoverhältnis - Pharmakokinetik - Medikamenteninteraktionen - akute Blutung

Ergänzendes Material

 

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