Antikoagulation bei neurologischen Erkrankungen – Stellenwert und Indikation neuer Substanzen

Der Nachweis der Wirksamkeit und Sicherheit von neuen oralen Antikoagulantien (NOAK) bei Patienten mit Vorhofflimmern stellt einen Meilenstein für die Primär- und Sekundärprophylaxe von Schlaganfällen dar. Die Kenntnis der pharmakologischen Eigenschaften der Substanzen ist für die Patientenauswahl und langfristige Patientenbetreuung wesentlich. Neben der Sicherung der Patientenadhärenz bestehen aktuelle Herausforderungen aus neurologischer Sicht in der Behandlung von akuten Hirnischämien und Hirnblutungen unter neuen OAK. Neue orale Antikoagulantien sollten jedoch in der Regel nur in den zugelassenen Indikationen verschrieben werden, da Daten zu alternativen Indikationen fehlen.

Demonstration of efficacy and safety of new oral anticoagulants (OAC) in patients with atrial fibrillation is a milestone for the primary and secondary prevention of stroke. Knowledge of the specific pharmacological properties of the drugs is essential for patient selection and long-term medical care. From the neurologist's point of view assurance of drug adherence and treatment of acute ischemic and hemorrhagic stroke under new oral anticoagulants are current challenges associated with new OAC. Usage of new oral anticoagulants should be limited in general to the approved indications in the lack of evidence for further indications.

Key words

TIA - acute ischemic and hemorrhagic stroke - atrial fibrillation - oral anticoagulants

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