Tiefe Beinvenenthrombose und venöse Thromboembolie/Lungenembolie – Update Antikoagulation

Die tiefe Beinvenenthrombose (TBVT) ist die häufigste Ursache einer venösen Thromboembolie, die sich in der Regel durch eine Lungenarterienembolie manifestiert. Nach der Diagnosestellung sollten unabhängig von der Risikoeinschätzung alle Patienten mit tiefer Beinvenenthrombose und akuter Lungenarterienembolie eine frühzeitige Antikoagulation erhalten. Heparine gehören zur Standardtherapie der TBVT und Thromboembolie und werden vor allem in der initialen Phase der Therapie angewendet. Vitamin K-Antagonisten (VKA) gehörten bisher zur Standardtherapie in der Sekundärprävention der Thromboembolie. In Deutschland stehen Phenprocoumon und Warfarin zur Verfügung, wobei ersteres vorwiegend eingesetzt wird. Die Nachteile von VKA können durch die neuen direkten oralen Antikoagulanzien (DOAK) vermieden werden. Vorteil der DOAK ist der schnelle Wirkungseintritt sowie eine weniger variable Pharmakokinetik. Insbesondere das günstigere Sicherheitsprofil bezüglich Blutungsereignisse und die einfachere Steuerbarkeit bieten Vorteile gerade in der ambulanten Behandlung. Nach der akuten Phase fokussiert sich die weitere Behandlung auf die Prävention eines Rezidivs. Die Dauer der Therapie sollte individuell nach Abwägung des Rezidiv- und Blutungsrisikos erfolgen.

Deep leg vein thrombosis (DLVT) is the most common cause of venous thromboembolism and as a rule is manifested as a pulmonary artery embolism. After diagnosis, and independently of the risk assessment, all patients with deep leg vein thrombosis and acute pulmonary artery embolism should receive anticoagulation as early as possible. Heparins belong to the standard therapy for DLVT and thromboembolism and are administered especially in the initial phases of therapy. Vitamin K antagonists (VKA) up to now also belonged to the standard therapy for thromboembolism. In Germany phenprocoumon and warfarin are available whereby the former is more widely used. The disadvantages of VKA can be reduced by use of the new direct oral anticoagulants (DOAC). The advantage of DOAC is their rapid onset of action without the need for an initiation phase with heparins as well as their less variable pharmacokinetics. Above all, their more favorable safety profile with regard to bleeding events and their easier controllability are advantageous, especially for outpatient treatment. After the acute phase, further treatment focuses on the prevention of recurrences. The duration of therapy is determined on a case by case basis under consideration of the risks for a recurrence and for rebleeding.

Key words

Deep leg vein thrombosis - venous thrombembolism - pulmonary artery embolism - risk assessment - anticoagulation - heparins - vitamin K antagonists - direct oral anticoagulants (DOAC) - bleeding risk

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