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Neue Antikoagulanzien zur Schlaganfallprävention bei Vorhofflimmern

New anticoagulants for stroke prevention in atrial fibrillation

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Zusammenfassung

Patienten mit Vorhofflimmern haben ein hohes Schlaganfallrisiko. Dieses Risiko kann durch Vitamin-K-Antagonisten wie Phenprocoumon oder Warfarin sowohl in der Primär- als auch in der Sekundärprävention, verglichen mit Placebo, um 60–70% reduziert werden. Vitamin-K-Antagonisten haben allerdings eine Vielzahl von Problemen in der praktischen Anwendung, was die relativ geringe Einnahmefrequenz bei Patienten mit Vorhofflimmern erklärt. Neue orale Antikoagulanzien wie direkte Thrombininhibitoren (Dabigatran) oder direkte Faktor-Xa-Hemmer wie Rivaroxaban und Apixaban zeigten eine im Vergleich zu Warfarin mindestens ebenbürtige wenn nicht höhere Wirksamkeit und zum Teil auch eine niedrigere Inzidenz an schwerwiegenden Blutungskomplikationen. Die neuen Substanzen sind sowohl in der Sekundär- als auch in der Primärprävention von Schlaganfällen bei Patienten mit Vorhofflimmern wirksam. Apixaban ist auch deutlich wirksamer als Azetylsalizylsäure bei Patienten, die für eine Behandlung mit Warfarin nicht geeignet sind, bei vergleichbarer Rate an schwerwiegenden Blutungskomplikationen.

Abstract

Oral anticoagulation with vitamin K antagonists (warfarin, phenprocoumon) is successful in both primary and secondary stroke prevention for patients with atrial fibrillation (AF), yielding a 60–70% relative reduction in stroke risk compared with placebo and a mortality reduction of 26%. However, these agents have a number of well documented shortcomings. This review describes the current landscape and developments in stroke prevention in patients with AF with special reference to secondary prevention. A number of new drugs for oral anticoagulation that do not exhibit the limitations of vitamin K antagonists are under investigation. These include direct factor Xa inhibitors and direct thrombin inhibitors. Recent studies (RE-LY, ROCKET-AF, AVERROES, ARISTOTLE) provide promising results for these new agents including higher efficacy and significantly lower incidences of intracranial bleeding compared with warfarin. The new substances show similar results in secondary as well as in primary stroke prevention in patients with AF. The new anticoagulants add to the therapeutic options for patients with AF and offer a number of advantages over warfarin for both clinician and patient, including a favorable bleeding profile and convenience of use. Consideration of these new anticoagulants will improve clinical decision-making.

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Authors and Affiliations

  1. Klinik für Neurologie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland

    H.C. Diener, K. Hajjar & B. Frank

  2. Klinik für Kardiologie, Universitätsklinikum Essen, Essen, Deutschland

    M. Perrey

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  1. H.C. Diener
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  2. K. Hajjar
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Correspondence to H.C. Diener.

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Diener, H., Hajjar, K., Frank, B. et al. Neue Antikoagulanzien zur Schlaganfallprävention bei Vorhofflimmern. Herz 37, 370–377 (2012). https://doi.org/10.1007/s00059-012-3617-x

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