Antikoagulationsbehandlung

Anticoagulation is a medical strategy that reduces blood’s ability to clot, thereby preventing thrombus formation and propagation. Anticoagulants are used when clots can cause serious harm, such as stroke in atrial fibrillation, pulmonary embolism, deep vein thrombosis, or after certain surgeries. They differ from antiplatelet drugs, which target platelets, and from thrombolytics, which break down clots.

Drug classes include indirect and direct oral anticoagulants. Vitamin K antagonists (e.g., warfarin) inhibit synthesis of vitamin K–dependent clotting factors and require regular laboratory monitoring (INR) and dietary considerations. Direct oral anticoagulants act by directly inhibiting thrombin (dabigatran) or factor Xa (rivaroxaban, apixaban, edoxaban) and are often used for nonvalvular atrial fibrillation and venous thromboembolism, with some differences in bleeding risk profiles compared with warfarin. Parenteral anticoagulants include unfractionated heparin and low-molecular-weight heparins (enoxaparin), which are used in hospital settings for acute thrombotic events or bridging therapy.

Safety and management: Before starting therapy, clinicians assess bleeding risk and kidney function. Monitoring is routine for warfarin but not for most DOACs. Reversal strategies exist for major bleeding, such as vitamin K and plasma for warfarin, protamine sulfate for heparin, and specific antidotes for certain DOACs in appropriate contexts. Anticoagulation requires individualized decisions, considering patient factors, thrombotic risk, bleeding risk, and potential interactions with other medicines and foods.