Bleeding with anticoagulant treatments

 

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Summary

Anticoagulation with vitamin K antagonists (VKAs) is effective in the prevention and treatment of thrombotic complications in many clinical conditions, including atrial fibrillation (that represents today the most frequent indication for anticoagulant treatment), venous thromboembolism, acute coronary syndromes and after invasive cardiac procedures. Bleeding is the most important complication of VKAs and a major concern for both physicians and patients, limiting a more widespread prescription of the treatment. As a result, a non negligible proportion of all the subjects who would have a clear clinical indication for anticoagulation do not receive an effective treatment.

This review analyses the treatment- and person-associated risk factors for bleeding during VKAs. New oral anticoagulant drugs seems to overcome at least some of the limitations of VKAs. Potentially, they can allow a less demanding and more stable anticoagulant treatment, with less side-effects allowing that more patients can receive an appropriate anticoagulant treatment. Based on the so far available phase III clinical studies, it is possible to assume that these new drugs are associated with a risk of bleeding, that is probably related to the intensity of treatment.

Zusammenfassung

Die Antikoagulation mit Vitamin-K-Antagonisten (VKA) ist in der Prävention und Therapie von thrombotischen Komplikationen bei vielen Krankheitsbildern wirksam: u. a. bei Vorhofflimmern (zurzeit die häufigste Indikation für eine Antikoagulanzientherapie), venöse Thromboembolien, akutes Koronarsyndrom und nach invasiven kardialen Interventionen. Blutungen sind die wichtigste Komplikation der VKA-Gabe und die größte Sorge von Ärzten und Patienten, was die breitere Ver ordnung von VKA einschränkt. Daraus folgt, dass ein erheblicher Teil der Patienten, bei denen eine klare Indikation für eine Antikoagulation bestehen würde, keine wirksame Therapie erhält.

In dieser Übersicht analysieren wir die behandlungs- und patientenbezogenen Risikofaktoren für Blutungen unter VKA. Mit neuen oralen Antikoagulanzien scheinen einige der Einschränkungen der VKA überwunden zu sein. Möglicherweise gestatten sie eine weniger aufwändige und stabilere Antikoagulanzientherapie mit weniger unerwünschten Arzneimittelwirkungen, so dass mehr Patienten eine adäquate gerinnungshemmende Therapie erhalten können. Den vorliegenden klinischen Phase-III-Studien zufolge ist davon auszugehen, dass auch die neuen Antithrombotika mit einem Blutungsrisiko verbunden sind, das wahrscheinlich von der Intensität der Behandlung abhängig ist.

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