Spezifische Pharmakotherapie bei intrazerebralen Blutungen unter oraler Antikoagulation

Intrazerebrale Blutungen (ICB) gehen mit einer hohen Mortalität und Morbidität einher. Insbesondere die ICB unter oraler Antikoagulation (OAK) stellt eine therapeutische Herausforderung dar. Bei einer OAK-assoziierten ICB ist ein wesentliches Therapieziel die Wiederherstellung der Hämostase. Dieser Übersichtsartikel beschreibt die Indikationen, Anwendung und Wirksamkeit der spezifischen Gegenmittel bei ICB unter OAK anhand der aktuellen Literatur.

Kernaussagen

• Patienten, die eine intrazerebrale Blutung (ICB) unter Vitamin-K-Antagonisten (VKA) bei einer INR (= International Normalized Ratio) > 1,2 erleiden, sollten Prothrombin-Komplex-Konzentrat (PPSB) (je nach INR-Wert, mindestens 30 U/l) und Vitamin K 10 mg i. v. erhalten.

• Patienten mit ICB unter Dabigatran können Idarucizumab erhalten (2 × 2,5 g i. v.).

• Bei einer intrazerebralen Blutung unter den FXa-Hemmern Rivaroxaban und Apixaban kann eine Antagonisierung mit Andexanet alfa erwogen werden.

• Die Dosierung von Andexanet alfa richtet sich nach dem Zeitpunkt der letzten Einnahme und Tagesdosis des Antikoagulans. Alternativ kann eine Antagonisierung mit PPSB (50 U/kgKG) erwogen werden.

• Für Patienten mit intrakraniellen Blutungen unter dem FXa-Hemmer Edoxaban steht keine spezifische zugelassene Therapie zur Verfügung. Es kann eine Antagonisierung mit PPSB (50 U/kgKG) erwogen werden.

• Bei hohem Rezidivrisiko für eine intrazerebrale Blutung kann bei Patienten mit Vorhofflimmern alternativ die Implantation eines Vorhofohrokkluders erwogen werden.

Schlüsselwörter

intrakranielle Blutungen - Andexanet alfa - Idarucizumab - Antagonisierung - Antikoagulanzien

Publication History

Article published online:
30 June 2023

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