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Therapie der Beinvenenthrombose

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Antithrombotic treatment of deep vein thrombosis

  • Schwerpunkt: Was ist gesichert in der Therapie?
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Zusammenfassung

Bei der antithrombotischen Therapie der tiefen Venenthrombose (TVT) unterscheidet man eine initiale Phase mit sofort wirksamen Antithrombotika und eine anschließende längerfristige Sekundärprophylaxe. Für die Initialbehandlung hat sich die s.c.-Gabe von niedermolekularen Heparinen durchgesetzt, wobei die Kontraindikation der Niereninsuffizienz beachtet werden muss, die zur Kumulation führen könnte. Als neues, sofort wirksames Antithrombotikum steht in Kürze das synthetische Pentasaccharid Fondaparinux zur Verfügung. Die Sekundärprophylaxe der TVT mit Vitamin-K-Antagonisten ist hocheffektiv. Auch nach aktuellen Studien ist der dabei anzustrebende Zielbereich eine INR von 2,0–3,0. Die Dauer der oralen Antikoagulation richtet sich nach dem mutmaßlichen Rezidivrisiko. Wegen des engen therapeutischen Fensters der Vitamin-K-Antagonisten wird bei Patienten mit erhöhtem Blutungsrisiko zunehmend niedermolekulares Heparin zur Sekundärprophylaxe eingesetzt, meist in der halben therapeutischen Dosis. Derzeit werden zahlreiche neue Antithrombotika geprüft, die möglicherweise in absehbarer Zeit die Thrombosetherapie weiter vereinfachen und sicherer machen könnten.

Abstract

Current antithrombotic therapy of deep vein thrombosis (DVT) consists of an initial course of heparin, followed by the secondary prevention with oral anticoagulation (OAC). Low molecular weight heparin has several advantages over unfractionated heparin, however, renal insufficiency has to be observed to avoid accumulation. The synthetic pentasaccharide Fondaparinux is a factor Xa inhibitor, that will shortly be available for the initial treatment of DVT. Oral anticoagulation with vitamin K antagonists (VKA) is highly effective, the standard target INR is 2.0–3.0. For a first episode of DVT the duration of OAC usually is six months, but has to be adjusted according to the estimated risk for recurrence. Because of the narrow therapeutic window of VKA, low molecular weight heparins are increasingly being used for secondary prevention in patients with an increased risk for bleeding, mostly in 1/2-therapeutic dose. At present, several new antithrombotic agents are being studied and may become available shortly for DVT treatment.

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  1. Medizinische Klinik IV, Max-Ratschow-Klinik für Angiologie, Klinikum Darmstadt

    R. M. Bauersachs

  2. Medizinische Klinik IV, Max-Ratschow-Klinik für Angiologie, Klinikum, Heidelberger Landstraße 379, 64297, Darmstadt

    R. M. Bauersachs

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Bauersachs, R.M. Therapie der Beinvenenthrombose. Internist 45, 1345–1355 (2004). https://doi.org/10.1007/s00108-004-1302-8

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