Vorhofflimmern: Wie effektiv und sicher sind die direkten oralen Antikoagulanzien zur Prävention von Schlaganfällen?

Zusammenfassung

Die Entwicklung der direkten oralen Antikoagulantien stellt einen der größten medizinischen Fortschritte der letzten 10 Jahre dar. Im Vergleich zu den Vitamin K Antagonisten sind diese Medikamente (Dabigatran als Thrombin-Inhibitor, Rivaroxaban, Apixaban und Edoxaban als Faktor Xa Hemmer) aufgrund ihrer pharmakologischen Eigenschaften ungleich einfacher anzuwenden. Alle direkten oralen Antikoagulantien weisen eine bessere Wirksamkeit und eine höhere Sicherheit als die Vitamin K Antagonisten auf, wie in den entsprechenden Zulassungsstudien an mehr als 71 000 Patienten gezeigt worden ist. Insbesondere die viel geringere Häufigkeit intrakranieller Blutungen machen die DOACs zu Medikamenten der ersten Wahl für die primäre und sekundäre Schlaganfallprävention bei nicht-valvulärem Vorhofflimmern.

Abstract

The development of the direct oral anticoagulants (DOACs) represents one of the major breakthroughs in modern medicine over the last decade. Compared to vitamin K antagonists, all DOACs (dabigatran as a thrombin-Inhibitor, rivaroxaban, apixaban and edoxaban as factor Xa inhibitors) are much easier to handle due to their pharmacological properties. All DOACS are more efficacious and safer as vitamin K antagonists as demonstrated in the pivotal studies in more than 71 000 patients. Particularly the much lower risk of intracerebral bleeding complications is the reason why the DOACs should be preferred over vitamin K antagonists in patients with non-valvular atrial fibrillation.

Schlüsselwörter

Nicht-valvuläres Vorhofflimmern - Schlaganfall-Prävention - direkte orale Antikoagulantien

Keywords

Non-valvular atrial fibrillation - stroke prevention - direct oral anticoagulants

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