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Nephrologie aktuell 2024; 28(03): 132-138
DOI: 10.1055/a-2215-3704
Schwerpunkt
Nephrologie

Antikoagulation bei abnormer Nierenfunktion oder Dialyse

Schlaganfall- und Embolieprohylaxe bei Patienten mit Vorhofflimmern
Vincent Brandenburg
1   Klinik für Kardiologie und Nephrologie, Rhein-Maas Klinikum GmbH, Würselen
,
Gunnar Henrik Heine
2   Medizinische Klinik II, Agaplesion Markus Krankenhaus, Frankfurt am Main
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ZUSAMMENFASSUNG

Patienten mit Vorhofflimmern (VHF) und erhöhtem Risiko für Schlaganfall und systemische Embolie (SSE) sind mit CKD G1–3 (CKD: „chronic kidney disease“) klare Kandidaten für eine Therapie mit neuen orale Antikoagulanzien (NOAK). Patienten mit VHF und erhöhtem SSE-Risiko sind mit CKD 4 wahrscheinlich gute Kandidaten für eine NOAK-Therapie; Vitamin-K-Antagonisten (VKA) sind hier formal kontraindiziert. Keine Art der oralen Antikoagulation (OAK) ist bei Dialysepatienten in Europa explizit zugelassen. Es ist unklar, ob Dialysepatienten von irgendeiner OAK hinsichtlich ischämischem Schlaganfallrisiko und Mortalität bei akzeptablem Blutungsrisiko profitieren. Die Therapie mit einem NOAK ist auch bei Dialyse möglich. Eine Aufklärung über den Off-Label-Gebrauch sollte erfolgen. Die Studie VALKYRIE deutet an, dass eine Rivaroxaban-Therapie (10 mg/d) bei Dialysepatienten eine höhere Effektivität und Sicherheit hat als eine VKA-Therapie. Die Implantation eines LAA-Okkluders kann eine recht sichere und effektive Alternative zur OAK bei Dialysepatienten sein. Hierzu sollte eine Entscheidung durch ein Behandlungsteam gesucht werden.



Publication History

Article published online:
19 April 2024

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