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Notfallmedizin up2date 2023; 18(01): 81-98
DOI: 10.1055/a-1724-4900
Neurologische Notfälle

Spezifische Pharmakotherapie bei intrazerebralen Blutungen unter oraler Antikoagulation

Ida Rangus‡
,
Regina von Rennenberg‡
,
Christian H Nolte 
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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


Publikationsverlauf

Artikel online veröffentlicht:
13. März 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
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