Prävention intrakardialer Thromben und systemischer Embolien nach Herzklappenersatz

Zusammenfassung

Obwohl bislang keine prospektiven Dosisfindungsstudien durchgeführt wurden, wird für Patienten mit mechanischen Herzklappenprothesen eine orale Dauerantikoagulation mit einer Intensität von INR 3,0-4,5 empfohlen. Jüngste Untersuchungen zum optimalen Management einer oralen Antikoagulation bei Kunstklappenträgern belegen (a) die Unzulänglichkeit der Therapiesteuerung mittels des Quick-Wertes, (b) Unterschiede in der Thrombogenität älterer wie auch der heute verfügbaren Prothesen, (c) die Notwendigkeit einer individuellen Antikoagulation aufgrund der patientenseitigen Koagulabilität, (d) die Berücksichtigung der unabhängig von der implantierten Prothese zu intrakardialen Thrombosen und konsekutiven Embolien prädisponierenden kardialen Morphologie und Physiologie.

Schlüsselwörter

Orale Antikoagulation - Herzklappenprothesen - Thrombogenität - Thrombembolien - Antikoagulation - INR - Kardioembolien - St.-Jude-Medical-Prothese

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