Inhaltszusammenfassung

This dissertation highlights new aspects in the field of oral anticoagulation. Firstly, the influence of the long established vitamin K antagonists (VKA) and the alternative direct oral anticoagulants (DOAC) on subclinical parameters of cardiovascular disease was investigated. Furthermore, the work provides new findings in the field of health care research and considers high-risk groups for reduced therapeutic quality and clinical outcome. Oral anticoagulants are prescribed for primary and s...This dissertation highlights new aspects in the field of oral anticoagulation. Firstly, the influence of the long established vitamin K antagonists (VKA) and the alternative direct oral anticoagulants (DOAC) on subclinical parameters of cardiovascular disease was investigated. Furthermore, the work provides new findings in the field of health care research and considers high-risk groups for reduced therapeutic quality and clinical outcome. Oral anticoagulants are prescribed for primary and secondary prevention of thromboembolic diseases. Main indications are atrial fibrillation, venous thromboembolism (i.e., pulmonary embolism, deep vein thrombosis) and mechanical heart valves. With the introduction of DOAC in 2008, alternatives to the established VKA became available. Since not only coagulation factors but also other proteins are targets of VKA and DOAC, anticoagulation therapy might exert pleiotropic effects. Investigations in this thesis have demonstrated that oral anticoagulation therapy affects the development and course of subclinical parameters of cardiovascular disease differentially. It was shown for the first time that VKA therapy had a negative impact on arterial stiffness, vascular morphology, cardiac structure and function, and inflammation. In contrast, DOAC are linked to improved cardiac function and lipid metabolism. These results strengthen the notion that oral anticoagulants have an impact on the development and progression of cardiovascular disease, which, however, notably depends on the substance. These potential effects on the cardiovascular system underline the challenging situation regarding high quality oral anticoagulation therapy. In addition, clinical factors such as polypharmacy among elderly patients with atrial fibrillation contribute to the difficulty of obtaining high quality anticoagulation therapy at lowest risk of adverse events. Patients with polypharmacy have an increased risk of complications and adverse events, so it is believed that they need particular monitoring (e.g., regular control of kidney function and dose testing) to avoid over- and under-dosing. The present results are of high clinical relevance, as a combination of both, treatment quality and clinical phenotype, are important aspects for the development of individualized anticoagulation therapy. Specialized care could facilitate optimal personalized care in both VKA and DOAC treated patients as well as in high-risk patient groups.» weiterlesen» einklappen

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DDC Sachgruppe:
Medizin