Antithrombotische Therapie bei Patienten mit Herzklappenfehlern prä– und postoperativ – Standards und Tipps

Abstract

The risk of hemorrhages and thromboembolisms during permanent anticoagulation depends largely on the stability of the anticoagulation as long as a therapeutic „corridor” of INR 2,0-3,5 is maintained. Antithrombotics employed are oral anticoagulants, non-fractionated heparins, low-molecular weight heparins, platelet aggregation inhibitors (ASA or Clopidogrel) as well as new substances such as direct thrombin inhibitors and Xa antagonists. In many cases of congenital or acquired cardiac defects there is a distinctly increased risk of intracardial thrombus formation and embolization of thrombi due to a damaged endocardial endothelium. This often requires permanent oral coagulation recommendable. For example, mechanical prosthetic heart valves are thrombogenic, requiring permanent anticoagulation. Valve reconstructions with Dacron rings should be handled like patients with bioprostheses. Avoid any abrupt changes of the INR value since this significantly increases the risk of thromboembolism. The choice of the anticoagulant during pregnancy must be individual taking into account all possible maternal and fetal complications.