Established anticoagulants in secondary haemostasis

Summary

In respect to the actual discussion of new anticoagulants in secondary haemostasis, we will give a short review on established oral anti -coagulation with vitamin K antagonists and parenteral anticoagulation by use of heparin. The different cumarin derivatives phenprocoumon, warfarin, and acenocoumarol are compared concerning to the management and influence of pharmacogenetic and pharmacokinetic factors. Studies to improve the safety of oral anticoagulation by vitamin K supplementation will be briefly discussed. The therapy with heparins include until now some problems of dose-response control. It is necessary to pay attention to contra-indications even for well known anticoagulants. Examples for that will be given.

Zusammenfassung

Vor dem Hintergrund der Diskussion neuer Antikoagulanzien der sekundären Hämostase soll hier ein kurzer Überblick über die etablierte orale Antikoagulation mit Vitamin-K-Antagonisten und die parenterale Antikoagulation mit Heparin gegeben werden. Die Cumarin -derivate Phenprocoumon, Warfarin und Acenocoumarol werden hinsichtlich ihres Handlings und ihrer Beinflussung durch pharmakogenetische und pharmakinetische Faktoren verglichen. Versuche, durch Vitamin-K-Supplementierung die Sicherheit der Antikoagulation mit Vitamin-K-Antagonisten zu erhöhen, werden kurz vorgestellt. Zu den Aspekten der Heparintherapie gehören Fragen der Dosis/Wirkungskontrolle, die noch nicht abschließend geklärt sind. Die Notwendigkeit, auch bei bewährten Präparaten auf relative und absolute Kontraindikationen zu achten, wird anhand von Beispielen erläutert.

Keywords

Vitamin K - vitamin K antagonists - unfractionated heparin - low-molecular-weight heparins

Schlüsselwörter

Vitamin K - Vitamin-K-Antagonisten - unfraktioniertes Heparin - niedermolekulare - Heparine

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