Orale Antikoagulation bei Erwachsenen mit angeborenen Herzfehlern

Zusammenfassung

Patienten mit angeborenen Herzfehlern weisen ein erhöhtes Risiko für das Auftreten thrombembolischer Ereignisse auf. Je nach zugrunde liegender Anatomie/operativer Korrektur ist dieses Risiko jedoch individuell sehr unterschiedlich und lässt sich weder hinsichtlich Embolierisiko noch hinsichtlich Blutungsrisiko durch die gängigen Risikoscores (z. B. CHA₂DS₂-VASc oder HAS-BLED) verlässlich abbilden. Neben der Frage der Indikationsstellung zur oralen Antikoagulation ist die Frage nach der Möglichkeit des Einsatzes neuer oraler Antikoagulanzien (NOAK) anstelle der Standardtherapie mit Vitamin-K-Antagonisten (VKA) eine immer drängendere, sofern kein mechanischer Klappenersatz und keine schwergradige Mitralstenose vorliegt. Bei atrialen Arrhythmien/Vorhofflimmern können nach momentaner Datenlage Patienten mit als „leicht“ klassifizierbaren Vitien mit NOAK behandelt werden, während Patienten mit mittelgradigen oder schweren/komplexen Herzfehlern eher mit VKA behandelt werden sollten.

Abstract

Patients with congenital heart disease (GUCH) are at increased risk of thromboembolic events. This risk differs individually according to the underlying anatomy and method of surgical correction, respectively. Furthermore, thromboembolic risk stratification is hampered by the fact that currently available scores (such as CHA₂DS₂-VASc or HAS-BLED) have not been validated in the context of GUCH. Thus, the general indications for anticoagulation in different clinical scenarios need to be defined. Also, more clinical data are warranted regarding the use of non-vitamin K oral anticoagulants (NOAK) instead of vitamin K antagonists (VKA) in GUCH cases without mechanical valves or high-grade mitral stenosis. Currently available data support the use of NOAK in patients with atrial tachyarrhythmias and “minor” heart defects, whereas patients with heart defects of moderate or high complexity should be treated with VKA.

Schlüsselwörter

EMAH - orale Antikoagulation - Erwachsene mit angeborenen Herzfehlern

Keywords

adults with congenital heart defects - ACHD - oral anticoagulation

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