Perioperatives Management der Antikoagulation mit Rivaroxaban – Konsensus einer interdisziplinären Arbeitsgruppe

Neue orale Antikoagulanzien (NOAKs) erweitern das bisherige Spektrum der antithrombotischen Prophylaxe und Therapie entscheidend. NOAKs (z.B. Rivaroxaban, Apixaban, Dabigatranetexilat) können in fixen Dosierungen ohne routinemäßige Gerinnungskontrollen eingesetzt werden und bieten darüber hinaus weitere Vorteile im Vergleich zu herkömmlichen Antikoagulanzien. Trotz der wesentlich einfacheren Handhabung ist auch die orale Antikoagulation mit NOAKs eine hochwirksame Therapie, die sorgfältig eingeleitet und begleitet werden muss und bei der patienten- sowie krankheitsspezifische Faktoren zu berücksichtigen sind. Zu dieser Thematik fand im Juni 2012 in Frankfurt/Main eine Arbeitssitzung statt, in der eine interdisziplinäre Expertengruppe das perioperative Management der Antikoagulation mit Rivaroxaban erörterte. Im Fokus standen dabei 3 Szenarien der operativen Medizin: das perioperative Management von langzeitantikoagulierten Patienten, die sich einem elektiven Eingriff unterziehen müssen, die Durchführung von unaufschiebbaren notfallchirurgischen Eingriffen unter Rivaroxaban und die Stillung von Blutungen unter laufender Einnahme von Rivaroxaban.

New oral anticoagulation agents (NOACs) have decisively extended the current spectrum of antithrombotic prophylaxis and therapy. NOACs (e.g., rivaroxaban, apixaban, dabigatran etexilate) can be employed in defined doses without the need for regular coagulation controls and, in addition, exhibit further advantages in comparison with the previously used anticoagulants. Despite its considerably easier handling, oral anticoagulation with NOACs is still a highly effective therapy that must be initiated and monitored with great care, whereby patient- and disease-specific factors have to be taken into account. In June 2012 an interdisciplinary expert committee met in Frankfurt/Main to discuss the perioperative management of anticoagulation with rivaroxaban. The focus was placed on three scenarios of operative medicine: the perioperative management of patients under long-term anticoagulation therapy who have to undergo an elective operation, the performance of emergency operations that cannot be postponed under rivaroxaban, and the control of bleeding during ongoing therapy with rivaroxaban.

Key words

perioperative management - anticoagulation –antithrombotic prophylaxis - rivaroxaban

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