Orale Antikoagulanzien

Vitamin K antagonists (VKA) and heparins have been standard anticoagulants over the past decades. They are considered effective and safe but several drawbacks led to the development of new oral anticoagulants. These inhibit specifically either thrombin or factor Xa, have a short half-life, are characterized by fixed-dose administration and routine coagulation monitoring is not required. Direct oral anticoagulants (DOACs) are used increasingly more in patients with non-valvular atrial fibrillation or in the treatment or secondary prophylaxis of venous thromboembolism. In cases of unexpected bleeding or urgent surgery specific antagonist treatment could be necessary but specific antidotes are not yet available. Currently, there are only few laboratories which offer specific coagulation tests for monitoring DOACs; however, DOACs considerably influence coagulation tests and make interpretation difficult. This article gives an overview of oral anticoagulants and possibilities for monitoring as well as recommendations for the management of bleeding complications and perioperative strategies for patients treated with oral anticoagulants.