Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2014
[Perioperative management and therapy of bleeding complications].
The new oral anticoagulants directly inhibit either thrombin (Dabigatran, Pradaxa®,) or activated Factor X (rivaroxaban, Xarelto®, and apixaban, Eliquis®) and have been approved for thromboprophylaxis after hip and knee replacement surgery and stroke prevention in non-valvular atrial fibrillation. Moreover, rivaroxaban has been approved for the treatment of deep venous thrombosis, prevention of pulmonary embolism and anticoagulation after acute myocardial infarction. The direct FXa-inhibitor edoxaban (Lixiana®) expects approval for the prevention of stroke in atrial fibrillation in Germany in 2014. ⋯ Due to the high protein binding the direkt FXa-inhibitors rivaroxaban (Xarelto®) and apixaban (Eliquis®) can not be hemodialysed. For edoxaban (Lixiana®) no data on elimination by renal replacement therapy are available. In case of life-threatening bleeding the replacement of a prothrombin complex preparation (PCC) containing the factors II, VII, IX and X and, second line, activated factor concentrates as recombinant factor VIIa or activated prothrombin complex preparations are recommended.
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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.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2014
[Children with respiratory infections - How and when to perform anesthesia].
Infections of the upper respiratory tract ( URI) are the most common preoperative encountered comorbidity in childhood. Whether anesthesia for a child with respiratory infection should be performed or better be canceled, is still a dilemma for many anesthetists. The reasons for this are understandable: respiratory infections are associated with an increased incidence of perioperative respiratory adverse events, and there have been no evidence-based recommendations for the procedure in the individual case. ⋯ Although most of them remain without serious sequelae they have potential for serious morbidity and mortality when not immediately diagnosed and treated. Risk factors for respiratory complications include age <1 year , pulmonary comorbidity, invasive airway and airway surgery. Hence the individual decision is dependant on the risk but also the benefit factors and the expertise of the medical team.