Monitoring of anticoagulants of secondary haemostasis

Summary

Vitamin K-antagonists and heparin belong to the established indirect acting anticoagulants. For many years these drugs were the only possibility for prophylaxis and treatment of venous and arterial thrombosis. The challenges for the routine laboratory related to the treatment with vitamin K-antagonists and heparin can be regarded as solved. However, in recent years a rapid development of new anticoagulants began. Although they are developed with guidelines for use without monitoring, the control of effective levels may be necessary in selected cases. As a consequence new challenges for the routine laboratory have to be solved. This paper presents an overview concerning monitoring methods.

Zusammenfassung

Vitamin-K-Antagonisten und Heparine sind etablierten indirekte Antikoagulanzien der sekundären Hämostase. Viele Jahre stellte die Gabe von Cumarinderivaten und/oder Heparinen die einzige Möglichkeit zur Prophylaxe und Behandlung von venösen und arteriellen Thrombosen dar. Die damit verbundenen Herausforderungen in Bezug auf ein Monitoring an das Routinelabor können als nahezu gelöst betrachtet werden.

In jüngster Zeit hat eine stürmische Entwick-lung auf dem Gebiet neuer Antikoagulanzien eingesetzt. Obwohl diese mit der Vorgabe entwickelt werden, ohne Monitoring auszukommen, ist die Kontrolle ihres Wirkspiegels in ausgewählten Fällen notwendig. Dies stellt das klinische Labor erneut vor Herausforderungen. Diese Arbeit bietet eine Übersicht der Methoden zum Monitoring.

Keywords

New anticoagulants - routine monitoring - chromogenic methods - direct thrombin inhibitors - direct factor Xa-inhibitors

Schlüsselwörter

Neue Antikoagulanzien - Routine-Monitoring - chromogene Methoden - direkte Thrombin -inhibitoren - direkte Faktor-Xa-Inhibitoren

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