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Der Internist

, Volume 58, Issue 5, pp 512–521 | Cite as

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
  • G. Schlieper
  • V. Schwenger
  • A. Remppis
  • T. Keller
  • R. Dechend
  • S. Massberg
  • S. Baldus
  • T. Weinreich
  • G. Hetzel
  • J. Floege
  • F. Mahfoud
  • D. Fliser
Arzneimitteltherapie

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.

Schlüsselwörter

Vorhofflimmern Nierenerkrankung Antikoagulanzien Phenprocoumon Warfarin 

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

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.

Keywords

Atrial fibrillation Renal disease Anticoagulants Phenprocoumon Warfarin 

Notes

Einhaltung ethischer Richtlinien

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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Copyright information

© Springer Medizin Verlag GmbH 2017

Authors and Affiliations

  • G. Schlieper
    • 1
    • 2
  • V. Schwenger
    • 3
  • A. Remppis
    • 4
  • T. Keller
    • 5
  • R. Dechend
    • 6
  • S. Massberg
    • 7
  • S. Baldus
    • 8
  • T. Weinreich
    • 9
  • G. Hetzel
    • 1
  • J. Floege
    • 2
  • F. Mahfoud
    • 10
    • 11
  • D. Fliser
    • 12
  1. 1.MVZ DaVita Rhein-RuhrDüsseldorfDeutschland
  2. 2.Medizinische Klinik II, Klinik für Nieren- und Hochdruckkrankheiten, Rheumatologische und Immunologische ErkrankungenUniklinik RWTH AachenAachenDeutschland
  3. 3.Klinik für Nieren- und Hochdruckkrankheiten, TransplantationszentrumKlinikum StuttgartStuttgartDeutschland
  4. 4.Klinik für Kardiologie, Pneumologie und kardiorenale MedizinHerz- und GefäßzentrumBad BevensenDeutschland
  5. 5.Medizinische Klinik III: Kardiologie, Angiologie, NephrologieUniversitätsklinikum FrankfurtFrankfurtDeutschland
  6. 6.HELIOS Klinikum Berlin-Buch und Experimental and Clinical Research CenterCharité – Campus BuchBerlinDeutschland
  7. 7.Medizinische Klinik und Poliklinik IKlinikum der Universität MünchenMünchenDeutschland
  8. 8.Klinik III für Kardiologie, Angiologie, Pneumologie und Internistische IntensivmedizinHerzzentrum der Universität zu KölnKölnDeutschland
  9. 9.Nephrologisches Zentrum Villingen-SchwenningenVillingen-SchwenningenDeutschland
  10. 10.Klinik für Innere Medizin III – Kardiologie, Angiologie und Internistische IntensivmedizinUniversitätsklinikum des SaarlandesHomburg/SaarDeutschland
  11. 11.Institute for Medical Engineering and ScienceMassachusetts Institute of TechnologyCambridge, MAUSA
  12. 12.Klink für Innere Medizin IV – Nieren- und HochdruckkrankheitenUniversitätsklinikum des SaarlandesHomburg/SaarDeutschland

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