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Dtsch Med Wochenschr 2022; 147(10): 617-624
DOI: 10.1055/a-1792-7094
Review

Sicherheit und Effektivität der oralen Antikoagulation bei Vorhofflimmern und Niereninsuffizienz im Praxisalltag

Safety and effectiveness of oral anticoagulation in patients with atrial fibrillation and renal insufficiency – a real-world perspective
Uwe Zeymer
1   Medizinische Klinik B, Kardiologie, Pneumologie, Angiologie und Internistische Intensivmedizin; Klinikum der Stadt Ludwigshafen am Rhein
,
Hendrik Bonnemeier
2   Klinik für Innere Medizin III, Kardiologie, Angiologie, Intensivmedizin; Universitätsklinikum Schleswig-Holstein, Kiel
,
Christoph Wanner
3   Medizinische Klinik I, Nephrologie; Universitätsklinikum Würzburg
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Zusammenfassung

Die momentanen Leitlinien empfehlen Nicht-Vitamin-K-abhängige orale Antikoagulanzien (NOAK) als Therapiestandard für die Schlaganfallprophylaxe bei Patienten mit Vorhofflimmern (VHF) und sind daher den Vitamin-K-Antagonisten (VKA) vorzuziehen. Diese Empfehlung gilt auch für Patienten mit VHF und chronischer nicht dialysepflichtiger Niereninsuffizienz. Sogenannte Real-World-Evidenz (RWE), also Daten aus der klinischen Praxis, erweitert und bestätigt die zugrunde liegende klinische Evidenz, die in den stärker formalisierten klinischen Prüfungen mit NOAK und VKA, hier ausschließlich Warfarin, gewonnen wurde. Darüber hinaus zeigte die RWE, dass die Überlegenheit der NOAK gegenüber dem VKA Warfarin auch für Phenprocoumon gilt, dem in Deutschland gebräuchlichsten VKA. Auch fanden sich Hinweise, dass bei Patienten mit chronischen Nierenerkrankungen das Fortschreiten der Nierenfunktionsstörung unter Behandlung mit NOAK geringer ausfallen kann als unter VKA.

Abstract

Non-vitamin-K dependent oral anti-coagulants (NOAC) are the current therapeutic standard for preventing strokes in patients with atrial fibrillation (AF) and should be preferred over vitamin K antagonists (VKA) in this indication. This recommendation applies also to patients with VHF and concomitant chronic kidney disease (CKD). Real World Evidence (RWE), i. e., structured data from clinical practice, extends and confirms the clinical evidence generated in more formalized clinical trials with NOAC and VKA. In addition, RWE in respect to the indication showed that the superiority of NOAC versus the VKA warfarin can also be extrapolated to phenprocoumon, the commonly used VKA in Germany. Furthermore, data include evidence that the typical progression of CKD appears to be less pronounced in individuals treated with NOAC compared to those treated with VKA.

Schlüsselwörter

NOAK - Phenprocoumon - Nierenversagen - Progression - Praxisdaten

Key words

NOAC - phenprocoumon - CKD - progression - real-world evidence

Supplement



Publication History

Article published online:
11 May 2022

© 2022. Thieme. All rights reserved.

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