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Dialyse aktuell 2021; 25(07): 273-278
DOI: 10.1055/a-1402-8764
Schwerpunkt
Nephrologie

Interventioneller Vorhofohrverschluss

Indikation bei chronisch nierenkranken Menschen
Boris Schmidt
1   Cardioangiologisches Centrum Bethanien, Medizinische Klinik 3 – Klinik für Kardiologie, Agaplesion Markus Krankenhaus, Frankfurt a. M.
,
Kyrill Rogacev
2   Klinik für Kardiologie, Sana Hanse-Klinikum Wismar, Wismar
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ZUSAMMENFASSUNG

Bedauerlicherweise existieren bisher keine randomisierten Studiendaten hinsichtlich des Stellenwerts eines Vorhofohrverschlusssystems (LAAC: „left atrial appendage closure“) im Vergleich zu oralen Antikoagulanzien (OAK) bei CKD-Patienten (CKD: „chronic kidney disease“). Eine derartige Studie (WATCH AFIB in CKD) wurde wegen geringer Rekrutierungszahlen eingestellt. Aus den im Beitrag angesprochenen Beobachtungsstudien kann allerdings eine gute Sicherheit und Effektivität der Therapie abgeleitet werden. In Anbetracht der unzureichenden Evidenz sollte bei VHF Patienten (VHF: Vorhofflimmern) mit CKD bis zu einer glomerulären Filtrationsrate (GFR) von 30 ml/min/1,73 m2 primär eine NOAK-Therapie (NOAK: neue OAK) verordnet werden. Im Falle von Blutungen kann dann gemäß Leitlinienempfehlung eine LAAC alternativ angeboten werden. Im Falle von Patienten mit dialysepflichtiger CKD muss eine individuelle Entscheidung getroffen werden, ob und wie eine Thromboembolieprophylaxe durchgeführt werden soll.



Publication History

Article published online:
10 September 2021

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