Neue orale Antikoagulanzien – Einfluss auf Gerinnungstests

Zusammenfassung

Mit den neuen oralen Antikoagulanzien (NOAC) stehen heute zusätzliche Präparate zur Prophylaxe und Therapie thromboembolischer Erkrankungen zur Verfügung. Sie entfalten ihre Wirkung entweder durch Hemmung der Gerinnungsfaktoren Xa oder IIa (Thrombin). Dadurch kommt es auch zu Veränderungen verschiedenster Hämostaseparameter (z. B. Thromboplastinzeit, aktivierte partielle Thromboplastinzeit). Aufgrund der relativ kurzen Halbwertszeiten sind diese Veränderungen starken Tagesschwankungen unterzogen. Zudem bestehen teilweise deutliche Unterschiede in der Sensitivität verschiedener Reagenzien auf die NOAC. Dieser Beitrag zeigt den Einfluss von Apixaban, Rivaroxaban (FXa-Inhibitoren) und Dabigatran (Thrombin-Inhibitor) auf die am häufigsten verwendeten Gerinnungstests. Der Einfluss ist abhängig vom Wirkprinzip des Medikaments und vom Testprinzip des jeweiligen Gerinnungstests. Durch Kenntnis dieser Zusammenhänge können die hämostaseologischen Laborresultate unter Einfluss von NOAC korrekt interpretiert werden.

Abstract

The new oral anticoagulants (NOACs) represent alternative antithrombotic agents for prophylaxis and therapy of thromboembolic diseases. They act either by inhibition of the clotting factor Xa or IIa (thrombin). As a consequence, they influence several coagulation assays (for example prothrombin time, activated partial thromboplastin time). Because of the short half-life of these new agents, these changes show great variations in the course of 24 hours. Furthermore, there are significant differences of laboratory results depending on the used reagents. We explain the influence of apixaban, rivaroxaban (factor Xa inhibitors) and dabigatran (thrombin inhibitor) on the most commonly used coagulation assays. Besides we show that this influence depends on the way of action of the drug as well as on the principle of the coagulation assay. Being aware of this relationships helps to interpret the results of coagulation assays under influence of NOACs correctly.

Schlüsselwörter

neue orale Antikoagulanzien (NOAC) - Gerinnungstests - Thromboplastinzeit - aktivierte partielle Thromboplastinzeit (aPTT)

Keywords

new oral anticoagulants - coagulation assays - prothrombin time - activated partial thromboplastin time

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