Kapsel statt Spritze

Zusammenfassung

Patienten nach großen orthopädischen Operationen wie Hüft- oder Kniegelenkersatz haben generell ein erhöhtes Risiko, eine venöse thromboembolische Komplikation (VTE) zu erleiden. VTE enden in Form einer Lungenembolie ofttödlich oder können sich als Spätfolge in chronischen Erkrankungen manifestieren. Therapiestandard zur VTE-Pro- phylaxesind niedermolekulare Heparine (NMH). Diese sind gut wirksam, müssen aber subkutan appliziert werden und bergen das Risiko einer heparininduzierten Thrombozytopenie (HIT). Wirksame derzeitzur Verfügung stehende Alternativen, die kein HIT-Risiko bergen, müssen ebenfalls subkutan injiziert werden. Die Studienergebnisse des in Phase-III befindlichen oralen direkten Thrombininhibitors Dabigatran etexilat sind vielversprechend. In zwei großen europäischen Studien zur VTE-Prophylaxe bei Kniegelenkersatz (RE-MODEL) bzw. bei Hüftgelenkersatz (RE-NOVA- TE) war Dabigatran etexilat hinsichtlich Wirksamkeit und Sicherheit dem Therapiestandard Enoxaparin ebenbürtig. Die allgemeinen Blutungsraten waren in allen Studienarmenvergleichbar niedrig, ebensowie die Inzidenz erhöhter Leberenzyme. Typische Komplikationen der NMH wie Allergien, HIT oder Hämatome lassen sich durch die orale Gabe weitgehend vermeiden.

Summary

After major surgery like hip or knee arthroplasty patients are on high risk of suffering a venous thromboembolism (VTE) such as pulmonary embolism which often ends fatal or with chronic diseases as a result. Mainly used for the prevention of VTE are low molecularweight heparins (LMWH). They are reasonable effective butrequire subcutaneous application and can cause heparin induced thrombocytopenia (HIT). Every currently available effective pharmaceutical for VTE-prevention which do notcause HIT also need in- jection.The results of phase III studies of an oral direct thrombin inhibitor Dabigatran etexilate are promising. Tw big European studies (RE-NOVATE for hip replacement and RE-MODEL for knee replacement) proved the same efficiency and safety of Dabigatran etexilate compared to therapy standard Enoxaparin.The generally bleeding events and incidence of increased liver enzymes were similar low in each study group. Known complications of LMWH like allergies, HIT or haematoma can be avoided through oral application of Dabigatran etexilate.

Schlüsselwörter

Venöse Thromboembolien - Dabigatran etexilat - REMODEL - RE-NOVATE

Keywords

Venous Thromboembolism - Dabigatran etexilate - REMODEL - RE-NOVATE

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