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Antikoagulation bei Patienten mit chronischer Niereninsuffizienz

Empfehlungen der Arbeitsgemeinschaft „Herz – Niere“ der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung und der Deutschen Gesellschaft für Nephrologie

Anticoagulation in patients with chronic kidney disease

Recommendations from the working group “Heart–Kidney” of the German Cardiac Society and the German Society of Nephrology

  • Arzneimitteltherapie
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Zusammenfassung

Indikationen zur Antikoagulation sind im Wesentlichen venöse thromboembolische Ereignisse, mechanische Herzklappen und Vorhofflimmern bei einem entsprechenden Risikoscore. Die in Studien überwiegend an nierengesunden Patienten erhobenen Daten können jedoch nicht immer auf Patienten mit chronischer Niereninsuffizienz übertragen werden. Die nicht-Vitamin-K-abhängigen oralen Antikoagulanzien (NOAK) sind bei höhergradiger Niereninsuffizienz überwiegend nicht empfohlen bzw. kontraindiziert. In Observationsstudien profitieren Dialysepatienten mit Vorhofflimmern nicht von einer Antikoagulation mit Kumarinen. Prospektive Studien stehen aus.

Abstract

Indications for anticoagulation are thromboembolic events, prosthetic heart valves, and atrial fibrillation with a corresponding risk score. Clinical trials have excluded patients with advanced chronic kidney disease and these data cannot be always generalized to patients with chronic kidney disease. Non-vitamin K antagonist oral anticoagulants (NOACs) are mostly not recommended or are contraindicated in advanced stages of chronic kidney disease. Observational studies have shown that dialysis patients with atrial fibrillation do not profit from coumarin anticoagulants; prospective studies are lacking.

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Authors and Affiliations

  1. MVZ DaVita Rhein-Ruhr, Bismarckstr. 101, 40210, Düsseldorf, Deutschland

    G. Schlieper & G. Hetzel

  2. Medizinische Klinik II, Klinik für Nieren- und Hochdruckkrankheiten, Rheumatologische und Immunologische Erkrankungen, Uniklinik RWTH Aachen, Aachen, Deutschland

    G. Schlieper & J. Floege

  3. Klinik für Nieren- und Hochdruckkrankheiten, Transplantationszentrum, Klinikum Stuttgart, Stuttgart, Deutschland

    V. Schwenger

  4. Klinik für Kardiologie, Pneumologie und kardiorenale Medizin, Herz- und Gefäßzentrum, Bad Bevensen, Deutschland

    A. Remppis

  5. Medizinische Klinik III: Kardiologie, Angiologie, Nephrologie, Universitätsklinikum Frankfurt, Frankfurt, Deutschland

    T. Keller

  6. HELIOS Klinikum Berlin-Buch und Experimental and Clinical Research Center, Charité – Campus Buch, Berlin, Deutschland

    R. Dechend

  7. Medizinische Klinik und Poliklinik I, Klinikum der Universität München, München, Deutschland

    S. Massberg

  8. Klinik III für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Herzzentrum der Universität zu Köln, Köln, Deutschland

    S. Baldus

  9. Nephrologisches Zentrum Villingen-Schwenningen, Villingen-Schwenningen, Deutschland

    T. Weinreich

  10. Klinik für Innere Medizin III – Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland

    F. Mahfoud

  11. Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA

    F. Mahfoud

  12. Klink für Innere Medizin IV – Nieren- und Hochdruckkrankheiten, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland

    D. Fliser

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Interessenkonflikt

D. Fliser weist auf folgende Beziehung hin: Honorar von Daiichi-Sankyo. G. Schlieper, V. Schwenger, A. Remppis, T. Keller, R. Dechend, S. Massberg, S. Baldus, T. Weinreich, G. Hetzel, J. Floege und F. Mahfoud geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Schlieper, G., Schwenger, V., Remppis, A. et al. Antikoagulation bei Patienten mit chronischer Niereninsuffizienz. Internist 58, 512–521 (2017). https://doi.org/10.1007/s00108-017-0220-5

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