Subscribe to RSS
DOI: 10.1055/s-0042-106732
Aktuelle Therapieoptionen bei (schweren) gastrointestinalen Blutungen
Recent therapeutic options of (severe) gastrointestinal bleedingsPublication History
Publication Date:
10 August 2016 (online)
![](https://www.thieme-connect.de/media/dmw/201616/lookinside/thumbnails/1167_10-1055-s-0042-106732-1.jpg)
Zusammenfassung
Mit Idarucizumab steht erstmals ein spezifisches Antidot zur Antagonisierung der Dabigatran-Wirkung bei schwerer Blutungskomplikation unter direkten oralen Antikoagulanzien (DOAK) zur Verfügung. In der endoskopischen Therapie schwerer gastrointestinaler Blutungen finden topisch aufzutragende Substanzen und neue Hämostase-Clips Beachtung in den neu erschienenen Leitlinien. Besonders bei rezidivierenden Ulkusblutungen können die neu entwickelten Clips eine Hämostase erreichen und eine Operation verhindern. Bei Patienten mit koronarer Herzkrankheit sollte ein liberaleres Transfusionsregime angewendet werden.
Abstract
With Idarucizumab, a specific antidote to antagonize the effect of dabigatran, is now available in severe bleeding complications under directly oral anticoagulants (DOAC). In endoscopic treatment of severe gastrointestinal bleeding are alternative treatment options also available with hemostasis sprays and new hemostasis clips. Especially in recurrent ulcer bleedings, the newly developed clips can achieve hemostasis and prevent an operational procedure. In patients with coronary heart disease, a liberal transfusion regimen should be considered.
-
Literatur
- 1 Ruff CT, Giugliano RP, Braunwald E et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 2014; 383: 955-962
- 2 van Es N, Coppens M, Schulman S et al. Direct oral anticoagulants compared with vitamin K antagonists for acute venous thromboembolism: evidence from phase 3 trials. Blood 2014; 124: 1968-1975
- 3 Gomez-Outes A, Terleira-Fernandez AI, Calvo-Rojas G et al. Dabigatran, Rivaroxaban, or Apixaban versus Warfarin in Patients with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis of Subgroups. Thrombosis 2013; 2013: 640-723
- 4 Abraham NS, Singh S, Alexander GC et al. Comparative risk of gastrointestinal bleeding with dabigatran, rivaroxaban, and warfarin: population based cohort study. BMJ 2015; 350: h1857
- 5 Lip GY, Windecker S, Huber K et al. Management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and / or undergoing percutaneous coronary or valve interventions: a joint consensus document of the European Society of Cardiology Working Group on Thrombosis, European Heart Rhythm Association (EHRA), European Association of Percutaneous Cardiovascular Interventions (EAPCI) and European Association of Acute Cardiac Care (ACCA) endorsed by the Heart Rhythm Society (HRS) and Asia-Pacific Heart Rhythm Society (APHRS). Eur Heart J 2014; 35: 3155-3179
- 6 Braun G, Messmann H, Labenz J et al. [Direct oral anticoagulation and gastrointestinal bleeding: Interventional therapy management]. Med Klin Intensivmed Notfmed 2015; 110: 510-514
- 7 Pollack Jr. CV, Reilly PA, Eikelboom J et al. Idarucizumab for Dabigatran Reversal. N Engl J Med 2015; 373: 511-520
- 8 Enriquez A, Lip GY, Baranchuk A. Anticoagulation reversal in the era of the non-vitamin K oral anticoagulants. Europace 2015; ohne Seitenzahl, DOI: 10.1093/europace/euv030.
- 9 Siegal DM, Curnutte JT, Connolly SJ et al. Andexanet Alfa for the Reversal of Factor Xa Inhibitor Activity. N Engl J Med 2015; 373: 2413-2424
- 10 Gralnek IM, Dumonceau JM, Kuipers EJ et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: a1-46
- 11 Denzer U, Beilenhoff U, Eickhoff A et al. [S2k guideline: quality requirements for gastrointestinal endoscopy, AWMF registry no. 021–022]. Z Gastroenterol 2015; 53: 1496-1530
- 12 Chen YI, Barkun A, Nolan S. Hemostatic powder TC-325 in the management of upper and lower gastrointestinal bleeding: a two-year experience at a single institution. Endoscopy 2015; 47: 167-171
- 13 Nagata N, Niikura R, Sakurai T et al. Safety and Effectiveness of Early Colonoscopy in Management of Acute Lower Gastrointestinal Bleeding on the Basis of Propensity Score Matching Analysis. Clin Gastroenterol Hepatol 2016; 14: 558-564
- 14 Villanueva C, Colomo A, Bosch A et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med 2013; 368: 11-21
- 15 Jairath V, Kahan BC, Gray A et al. Restrictive versus liberal blood transfusion for acute upper gastrointestinal bleeding (TRIGGER): a pragmatic, open-label, cluster randomised feasibility trial. Lancet 2015; 386: 137-144