Wie antikoaguliert man ältere und fragile Patienten?

Mit zunehmendem Alter steigt das Risiko für Thrombosen, Blutungen und Nierenfunktionsstörungen. In diesem Artikel werden Daten sowohl aus neuen Studien als auch aus Subgruppenanalysen wegweisender Studien zu Wirksamkeit und Sicherheit von DOAK (direkten oralen Antikoagulanzien) bei fragilen Patienten mit Indikation zur Antikoagulation ausgewertet, um neue Erkenntnisse zu gewinnen und Wege für die Antikoagulation dieser Patienten zu beschreiben.

Kernaussagen

• Auch bei fragilen Patienten mit Thrombose kommt es bei der Verwendung von NOAK nicht zur Reduktion der Initialdosis.

• Definition „fragil“: Patienten, die älter als 75 Jahre sind und/oder ein Körpergewicht unter 50 kg haben und/oder eine Kreatinin-Clearance unter 50 ml/min aufweisen.

• Bei fragilen Patienten mit erhöhtem bzw. ohne erhöhtes Blutungsrisiko ist ein Vorhofohrverschluss bei Vorhofflimmern als Alternative in Erwägung zu ziehen.

• Die Dauer der oralen Antikoagulation muss bei fragilen Patienten besonders kritisch begutachtet werden; wenn die Ursache der tiefen Venenthrombose passager ist, dann ist eher eine kurze Dauer zu empfehlen. Eine Mindestdauer von 3 Monaten sollte aber nicht unterschritten werden.

Schlüsselwörter

Antikoagulation - ältere Patienten - fragil - venöse Thromboembolien - Vorhofflimmern

Publication History

Article published online:
29 July 2022

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