Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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For stroke prevention in patients with atrial fibrillation and other indications new oral anticoagulants have been developed. These drugs are direct anticoagulants in contrast to the indirectly acting vitamin-K antagonists, which are used for decades as the only available drugs. ⋯ However, to transfer the benefit from the large scale studies to the real world conditions, physicians have to get clinical experience in using the new drugs. Especially drug interactions, impaired renal function and periinterventional bridging need special attention to ensure transfer of the new drugs benefits to daily life treatment.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2014
[New oral anticoagulantsRegional anaesthesia and new oral anticoagulants].
New oral anticoagulants (NOAC) are increasingly applied after hip and knee replacement and in patients with non-vavular atrial fibrillation. Patients with cardiac disease benefit from regional anaesthesia, especially catheter-provided postoperative pain relief, but are at higher risk for puncture-related haematoma when NOAC are applied simultaneously. ⋯ The respective time intervals are prolonged in patients with renal insufficiency, especially when Dabigatran is applied, until 36 to 72 h. In general, high risk patients with NOAC undergoing surgery benefit from an interdicsciplinary approach and from less traumatic techniques such as spinal anaesthesia or superficial peripheral nerve blocks.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2014
[New direct oral oral anticoagulants (DOACs) - indications of DOACs].
The direct oral anticoagulants (DOACs) were developed because of the urgent therapeutic need due to the deficits of vitamin K antagonist therapy. The predominant indications in internal medicine are the acute treatment and secondary prevention of deep venous thrombosis (DVT) and pulmonary embolism (PE) as well as stroke prevention in patients with atrial fibrillation. For the acute therapy and secondary prevention of DVT/PE the DOACS were non inferior to low-molecular-weight heparin (LMWH) plus vitamin K antagonists at a significantly reduced rate of severe bleeding complications. ⋯ The efficacy of Dabigatran (150mg bid) and Apixaban (5mg bid) are superior to warfarin, with Rivaroxaban being non-inferior to warfarin for stroke prevention. The rate of bleeding complications with Apixaban and Dabigatran (110mg bid) were significantly lower as with warfarin. The DOACs do represent a major therapeutic advantage in oral anticoagulation therapy of patients for the approved indications.