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Dtsch Med Wochenschr 2019; 144(23): 1642-1649
DOI: 10.1055/a-1008-5548
Review
© Georg Thieme Verlag KG Stuttgart · New York

Antikoagulation bei Patienten mit nichtvalvulärem Vorhofflimmern (nvVHF) und eingeschränkter Nierenfunktion (NI)

Anticoagulation in patients with non-valvular atrial fibrillation (nvAF) and chronic kidney disease (CKD)
Uwe Zeymer
1   Medizinische Klinik B, Kardiologie, Pneumologie, Angiologie und Internistische Intensivmedizin; Klinikum der Stadt Ludwigshafen am Rhein
,
Hendrik Bonnemeier
2   Klinik für Innere Medizin III, Kardiologie, Angiologie, Intensivmedizin; Universitätsklinikum Schleswig-Holstein, Kiel
,
Christoph Wanner
3   Medizinische Klinik I, Nephrologie; Universitätsklinikum Würzburg
› Author Affiliations
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Publication History

Publication Date:
21 November 2019 (online)

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Zusammenfassung

Nichtvalvuläres Vorhofflimmern (nvVHF) ist wegen des assoziierten Schlaganfallrisikos eine Hauptindikation der oralen Antikoagulation. Viele dieser Patienten zeigen eine eingeschränkte Nierenfunktion, die das Schlaganfall- und Blutungsrisiko erhöht. Bei Niereninsuffizienz und nvVHF werden Vitamin-K-Antagonisten (VKA) von den Leitlinien aufgrund der heterogenen Studienlage nur zurückhaltend empfohlen – laut Fachinformation sind sie bei manifester Nierenfunktionsstörung kontraindiziert. Neue orale Antikoagulanzien (NOAK) sind bei Patienten mit Niereninsuffizienz ab einer Kreatinin-Clearance (KrCl) von 25 oder 30 ml/min klinisch untersucht und zugelassen, die Faktor-Xa-Inhibitoren können auch bei einer KrCl > 15 ml/min angewendet werden. NOAK zeigen gegenüber VKA ein günstiges Nutzen-Risiko-Profil bei der Reduktion von Schlaganfällen, sonstigen thromboembolischen Ereignissen und Todesfällen einerseits und beim Auftreten von Blutungen andererseits und werden daher von den ESC-Leitlinien empfohlen.

Abstract

Due to the associated risk of stroke, non-valvular atrial fibrillation (nvAF) is a major indication for oral anticoagulation. Many patients suffer from chronic kidney disease (CKD), which increases the risk for stroke and for bleeding. Vitamin K antagonists (VKA) receive only cautious recommendations in guidelines for patients with CKD and nvVHF due to heterogeneous study results; their summaries of product characteristics contain contraindications for patients with manifest CKD. Novel oral anticoagulants (NOACs) have been investigated and are approved in CKD patients with a creatinine clearance (CrCl) ≥ 25 or 30 ml/min, factor Xa inhibitors can be used also if CrCl is > 15 ml/min. NOACs show an advantageous benefit-risk profile compared to VKA in reducing stroke, other thromboembolic events and death on the one hand and occurrence of bleedings on the other, and are recommended by the current ESC guidelines.

Schüsselwörter

NOAK - Niereninsuffizienz - Vorhofflimmern - VKA - Leitlinien

Key words

DOAC - chronic kidney disease - atrial fibrillation - VKA - guidelines

Supplement

 

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