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Gepubliceerd in:
01-07-2016 | Nascholing
Bloedverdunning anno 2016
Auteurs: Robert Willemsen, prof.dr. Geert Jan Dinant, prof.dr. Freek Verheugt, prof.dr. Hugo ten Cate, Nico Weerkamp
Gepubliceerd in: Huisarts en wetenschap | Uitgave 7/2016
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Samenvatting
Willemsen R, Dinant GJ, Verheugt F, Ten Cate H, Weerkamp N. Bloedverdunning anno 2016. Huisarts Wet 2016;59(7):312-8.
Naar aanleiding van vragen van huisartsen vatten we in dit artikel de actuele stand van zaken rond antitrombotische medicatie samen. We gaan in op de pathofysiologie van de trombusvorming en behandelen de verschillende soorten antitrombotische medicamenten die beschikbaar zijn. Vervolgens bespreken we per indicatie welke middelen de voorkeur hebben. Pathologische trombusvorming kan onderverdeeld worden in veneuze trombose (zoals bij longembolieën) en arteriële trombose (zoals bij hartinfarcten en herseninfarcten zónder atriumfibrilleren). In beide gevallen is er in de regel een indicatie voor preventie met antitrombotische middelen. In orale vorm zijn er twee soorten antitrombotische medicamenten: de plaatjesremmers en de orale anticoagulantia (OAC). Bij een verhoogd risico op arteriële trombose is er veelal een plaatjesremmer geïndiceerd. Dit is het geval bij stabiel kransslagaderlijden, een doorgemaakt herseninfarct en perifeer arterieel vaatlijden. Bij veneuze trombose of een risico daarop (zoals bij atriumfibrilleren, diepe veneuze trombose of longembolie) is er meestal een indicatie voor behandeling met een OAC. Per indicatie varieert de voorkeursbehandeling echter en soms is er plaats voor combinaties van verschillende antitrombotische medicamenten. Daarnaast moet men het bloedingsrisico per individuele patiënt meewegen, al vormt dat risico maar zelden een harde contra-indicatie voor antitrombotische medicatie. Combinaties van twee verschillende plaatjesremmers zijn in sommige situaties (tijdelijk) te prefereren boven monotherapie met één plaatjesremmer, bijvoorbeeld na een doorgemaakt myocardinfarct. Incidenteel kan men drie middelen combineren, bijvoorbeeld bij patiënten met een doorgemaakt myocardinfarct én atriumfibrilleren.
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Metagegevens
- Titel
- Bloedverdunning anno 2016
- Auteurs
-
Robert Willemsen
prof.dr. Geert Jan Dinant
prof.dr. Freek Verheugt
prof.dr. Hugo ten Cate
Nico Weerkamp
- Publicatiedatum
- 01-07-2016
- Uitgeverij
- Bohn Stafleu van Loghum
- Gepubliceerd in
-
Huisarts en wetenschap
/ Uitgave 7/2016
Print ISSN: 0018-7070
Elektronisch ISSN: 1876-5912 - DOI
- https://doi.org/10.1007/s12445-016-0187-9
