Therapie der venösen Thromboembolie mit neuen oralen Antikoagulanzien

Zusammenfassung

Mit den oral applizierbaren, direkten Throm-bin- (Dabigatranetexilat) und Faktor Xa-Inhibitoren (Rivaroxaban, Apixaban, Edoxaban) stehen zukünftig neue Antikoagulanzien zur Verfügung, die durch ihre rasch einsetzende Wirkung sowie die verlässliche Pharmakokinetik mit fixer Dosierung und ohne Notwendigkeit routinemäßiger Gerinnungstests das Potential besitzen, die Therapie der venösen Thromboembolie grundlegend zu verändern. Aus den umfangreichen, derzeit laufenden Phase-III-Studienprogrammen liegen bereits Ergebnisse sowohl für die Akuttherapie und Sekundärprophylaxe (Dabigatranetexilat, Rivaroxaban) als auch für die verlängerte Sekundärprophylaxe (Rivaroxaban) der venösen Thromboembolie vor. Um dem Ziel eines „idealen Antikoagulans” noch näher zu kom-men, besteht Entwicklungsbedarf im Hinblick auf verlässliche, allgemein verfügbare Labor-tests zur Quantifizierung der Wirkung bzw. der Plasmakonzentrationen in Notfallsituationen und der Verfügbarkeit spezifischer Antidote.

Summary

Based on the rapid onset of action and the predictable pharmacological profile with fixed doses and without the need for routine coagulation monitoring, the oral, direct thrombin inhibitors (Dabigatranetexilat) and Factor Xa inhibitors (Rivaroxaban, Apixaban, Edoxaban) represent a major advance in the medical treatment of venous thromboembolism. These substances currently undergo large scale phase-III-clinical evaluation, with already published promising results for acute treatment and secondary prophylaxis (Dabigatranetexilat, Rivaroxaban) as well as for extended secondary prophylaxis (Rivaroxaban) of venous thromboembolic disease. Reliable coagulation tests for monitoring the anticoagulatory effect in case of emergency and specific antidotes need to be developed in order to get even closer towards an „ideal anticoagulant”.

Schlüsselwörter

Venöse Thromboembolie - neue orale Anti-koagulanzien - direkte Faktor Xa-Inhibitoren - direkte Thrombininhibitoren

Keywords

Venous thromboembolism - new oral anticoagulants - direct thrombin inhibitors - direct Factor Xa inhibitors

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