Dtsch Med Wochenschr 2015; 140(16): 1227-1230
DOI: 10.1055/s-0041-102666
Klinischer Fortschritt
Verdauungs- und Stoffwechselkrankheiten
© Georg Thieme Verlag KG Stuttgart · New York

Neue orale Antikoagulanzien und Endoskopie – was ist zu beachten?

New oral anticoagulants and endoscopy – what do you have to consider?
Sven Pannach
1   Bereich Gastroenterologie, Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, TU Dresden
,
Jan Beyer-Westendorf
2   Universitäts GefäßCentrum, Universitätsklinikum Carl Gustav Carus, TU Dresden
› Author Affiliations
Further Information

Publication History

Publication Date:
11 August 2015 (online)

Zusammenfassung

Da nicht-Vitamin-K-antagonisierende orale Antikoagulanzien (NOAKs) immer häufiger verordnet werden und sich antikoagulierte Patienten oft einer Intervention unterziehen müssen, ist eine umfassende Kenntnis über den adäquaten peri-interventionellen Umgang mit diesen Substanzen erforderlich. Für Elektiv- und Notfallsituationen muss ein standardisiertes Vorgehen geplant werden. Infolge ihrer Pharmakokinetik ist das peri-interventionelle endoskopische Management der NOAKs vergleichsweise einfach. Ein Heparin-„Bridging“/“Switching“ ist in der Regel nicht erforderlich. Bei schweren Blutungen unter NOAKs muss frühzeitig eine Endoskopie in Betracht gezogen werden.

Abstract

Anti-coagulated patients often undergo endoscopic procedures and non-vitamin-K-antagonist oral anticoagulants (NOAC) are increasingly prescribed. Consequently, a comprehensive knowledge about the adequate peri-interventional handling of these substances is required. A standardized approach needs to be planned for elective and emergency situations. As a result of their pharmacokinetics, the peri-endoscopic management of NOAC is relatively easy – an heparin “bridging”/”switching” is usually not required. In case of a severe NOAC bleeding endoscopic treatment must be considered at an early stage.

 
  • Literatur

  • 1 Go AS, Hylek EM, Phillips KA et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 2001; 285: 2370-2375
  • 2 Heidbuchel H, Verhamme P, Alings M et al. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace 2013; 15: 625-651
  • 3 Douketis JD, Spyropoulos AC, Spencer FA et al. Perioperative management of antithrombotic therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141: e326S-e350S
  • 4 Eisen GM, Baron TH, Dominitz JA et al. Guideline on the management of anticoagulation and antiplatelet therapy for endoscopic procedures. Gastrointest Endosc 2002; 55: 775-779
  • 5 Boustière C, Veitch A, Vanbiervliet G et al. Endoscopy and antiplatelet agents. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2011; 43: 445-461
  • 6 Choung BS, Kim SH, Ahn DS et al. Incidence and risk factors of delayed postpolypectomy bleeding: a retrospective cohort study. J Clin Gastroenterol 2014; 48: 784-789
  • 7 Choudari CP, Palmer KR. Acute gastrointestinal haemorrhage in patients treated with anticoagulant drugs. Gut 1995; 36: 483-484
  • 8 Connolly SJ, Ezekowitz MD, Yusuf S et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009; 361: 1139-1151
  • 9 Patel MR, Mahaffey KW, Garg J et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 2011; 365: 883-891
  • 10 Holster IL, Valkhoff VE, Kuipers EJ et al. New oral anticoagulants increase risk for gastrointestinal bleeding: a systematic review and meta-analysis. Gastroenterology 2013; 145: 105-112.e15
  • 11 Beyer-Westendorf J, Pannach S. Increase of gastrointestinal bleeding with new oral anticoagulants: problems of a meta-analysis. Gastroenterology 2013; 145: 1162-1163
  • 12 Choudari CP, Rajgopal C, Palmer KR. Acute gastrointestinal haemorrhage in anticoagulated patients: diagnoses and response to endoscopic treatment. Gut 1994; 35: 464-466
  • 13 Beyer-Westendorf J, Förster K, Pannach S et al. Rates, management, and outcome of rivaroxaban bleeding in daily care: results from the Dresden NOAC registry. Blood 2014; 124: 955-962
  • 14 Majeed A, Hwang HG, Connolly SJ et al. Management and outcomes of major bleeding during treatment with dabigatran or warfarin. Circulation 2013; 128: 2325-2332
  • 15 Piccini JP, Garg J, Patel MR et al. Management of major bleeding events in patients treated with rivaroxaban vs. warfarin: results from the ROCKET AF trial. Eur Heart J 2014; 35: 1873-1880
  • 16 Beyer-Westendorf J, Gelbricht V, Förster K et al. Peri-interventional management of novel oral anticoagulants in daily care: results from the prospective Dresden NOAC registry. Eur Heart J 2014; 35: 1888-1896