Hjärta och kärl Rekommendationerna av hjärt-kärlläkemedel gäller lika för män och kvinnor och oberoende av kronologisk ålder. För sköra äldre patienter med kort förväntad återstående livslängd bör symtomatisk behandling och bibehållande av livskvalitet prioriteras före prevention.Prevention av hjärt-kärlsjukdomHälsosamma levnadsvanor är basen för kardiovaskulär prevention.Läs om Hälsosamma levnadsvanor sid xx Kardiovaskulär riskskattningKardiovaskulär riskskattning syftar till att uppskatta individens risk för allvarliga hjärt-kärlhändelser och ligger till grund för preventiv behandling, se nedan.Om riskskattning och riskvärdering av kardiovaskulära sjukdomar i primärvården; janusinfo.seKardiovaskulär prevention; viss.nuKardiovaskulär riskvärdering med SCORE2/SCORE2-OP/SCORE2-DIABETES; janusinfo.seRiskskattning och lipidsänkande behandling vid kronisk njursjukdom; janusinfo.seLipidsänkande behandlingHyperlipidemi; viss.nuAvancerade lipidrubbningar – utredning och behandlingsrekommendation; janusinfo.seDet finns ett starkt vetenskapligt stöd för minskad morbiditet och mortalitet med statinbehandling. Kardiovaskulär risk och LDL-kolesterolnivå styr behandlingen. Det föreligger en underanvändning av statiner bland patienter med etablerad aterosklerossjukdom, diabetes mellitus, familjär hyperkolesterolemi (FH) och kronisk njursjukdom.Återinsätt statin efter behandlingsavbrott. Börja med låg dos och titrera upp. Preparatbyte kan underlätta. Kombinera gärna med ezetimib. Det är viktigt att understödja följsamhet till statinbehandling. Om behandlingen avbryts kan återinsättning bli framgångsrik genom att börja med låg dos och titrera upp. Byte av statin bör övervägas vid biverkningar. Statinbiverkningar är dosberoende. Vid uttalat nedsatt njurfunktion (eGFR <30 mmol/l) beakta ökad risk för statinbiverkningar, dossänkning kan vara aktuellt. Muskelsymtom kan ha andra orsaker än statinbiverkan. Misstänk familjär hyperkolesterolemi (FH) vid totalkolesterol ≥8 mmol/l eller LDL ≥5 mmol/l hos vuxen i kombination med tidig (man <55 år, kvinna <60 år) aterosklerotisk hjärt-kärlsjukdom eller förstagradssläkting med tidig aterosklerotisk hjärt-kärlsjukdom. Målvärden för LDL utifrån kardiovaskulär riskTillstånd med mycket hög risk: målvärde LDL <1,4 mmol/lTillstånd med hög risk: målvärde LDL <1,8 mmol/lTillstånd med måttlig risk: målvärde LDL <2,6 mmol/lSTATINERI första handatorvastatinAtorvastatin …, Atorbir, Lipistad, Lipitor 10–80 mg/dygnI andra hand – vid biverkningar eller interaktionerrosuvastatinRosuvastatin ..., Crestor 5–40 mg/dygnInte för nyinsättningsimvastatinSimvastatin … 20–40 mg/dygnEn välfungerande simvastatinbehandling behöver inte bytas ut.KOLESTEROLABSORPTIONSHÄMMAREezetimibEzetimib …Tilläggsbehandling till statin för patienter som inte når önskvärda LDL-nivåer. Ezetimib kan även ges som monoterapi vid statinintolerans.Specialiserad vårdPCSK9-HÄMMAREPCSK9-hämmare kan övervägas som tillägg till maximal tolererad behandling med statin och ezetimib till patienter med aterosklerossjukdom, familjär hyperkolesterolemi (FH) eller patienter med diabetes mellitus typ 2 med mycket hög risk.Vid aterosklerossjukdom stärks indikation för PCSK9-hämmare vid kardiovaskulär händelse i närtid (senaste 2 åren), ateroskleros i flera organ, flera hjärtinfarkter eller LDL-kolesterol ≥2,6 mmol/l.Behandlingen ska inledas på specialistmottagningar inom kardiologi, endokrinologi, neurologi eller internmedicin. Det finns ingen ökad förekomst av allvarliga biverkningar eller andra komplicerande faktorer varför fortsatt förskrivning kan ske i primärvården hos stabila patienter.alirokumabPraluent*evolokumabRepatha**Begränsad subvention; tlv.seStatiner och tilläggsbehandlingar för kardiovaskulär prevention hos högriskpatienter ...; janusinfo.se PCSK9-hämmare – ett behandlingsalternativ för vissa patienter med högt kolesterolvärde; janusinfo.se Avancerade lipidrubbningar – utredning och behandlingsrekommendation; janusinfo.se Hyperlipidemi; viss.nu Aterosklerotisk hjärt-kärlsjukdom och samtidig diabetes mellitus typ 2 och/eller kronisk njursjukdomSGLT2-hämmare och GLP-1-analoger har visats förebygga hjärt-kärlhändelser och mortalitet hos patienter med aterosklerotisk hjärt-kärlsjukdom (ischemisk hjärtsjukdom, ischemisk stroke/TIA, perifer artärsjukdom) och samtidig diabetes mellitus typ 2. SGLT2-hämmare som tillägg till RAAS-blockad har njurskyddande effekt vid diabetes mellitus typ 2 och vid kronisk njursjukdom med albuminuri.Valet av behandling med SGLT2-hämmare och/eller GLP-1-analoger avgörs av samsjuklighet, se Diabetes mellitus typ 2 – behandlingsöversikt sid xx och Njursjukdomar sid xx.SGLT2-HÄMMAREdapagliflozinForxiga* 10 mgempagliflozinJardiance* 10 mg*Begränsad subvention; tlv.seObservera risk för ketoacidos även vid normala blodsockervärden. Gör behandlingsuppehåll vid akut sjukdom, vätskebrist och fasta. Patientinformation finns för utskrift på janusinfo.se. Den blodsockersänkande effekten av SGLT2-hämmare avtar med minskande njurfunktion och är låg vid eGFR <45 ml/min. Kardiovaskulär- och njurskyddande effekt finns även vid lägre eGFR. Kan nyinsättas ned till eGFR 20 ml/min. Se under Njursjukdomar sid xx.SGLT2-hämmare ska inte användas hos patienter med diabetes mellitus typ 1. SGLT2-hämmare vid diabetes mellitus typ 2, hjärt- kärl- eller njursjukdom; janusinfo.se GLP-1-ANALOGERdulaglutidTrulicity* injektion 1 gång per veckaliraglutidDiavic* injektion 1 gång per dagsemaglutidOzempic* injektion 1 gång per vecka*Begränsad subvention; tlv.seSe även Aterosklerotisk hjärt-kärlsjukdom under Diabetes mellitus typ 2 sid xxArteriell trombosprofylaxTrombosprofylax vid ischemisk hjärtsjukdom sid xxvid förmaksflimmer sid xxvid perifer artärsjukdom sid xxvid stroke och TIA sid xxASA eller annan trombocythämmande behandling rekommenderas inte som primärpreventiv behandling för patienter utan manifest aterosklerotisk sjukdom.Hypertoni Definitionen av hypertoni är ≥140/90 mm Hg på mottagning, ≥135/85 mm Hg vid hemblodtryck eller 24-timmars blodtrycksmätning (dygnsmedelvärde ≥130/80 mm Hg, dagmedelvärde ≥135/85 mm Hg eller nattmedelvärde ≥120/70 mm Hg). Hypertoni är den enskilt största behandlingsbara riskfaktorn för sjuklighet och förtida död. Mät blodtryck frikostigt. Hemblodtryck och/eller 24-timmars blodtrycksmätning rekommenderas och kan användas för att ställa diagnos. Hemblodtrycksmätning ökar patientens delaktighet och är värdefullt för att följa upp behandlingen. Det är viktigt att patienten mäter blodtrycket på ett korrekt sätt. För praktiskt tillvägagångssätt, se Hypertoni; viss.nu. 24-timmars blodtrycksmätning ger bättre information om diagnos och prognos än blodtrycksmätning på mottagningen.Hypertoni motiverar behandling med blodtryckssänkande läkemedel. Inled behandling av hypertoni med två läkemedel direkt. Detta för att uppnå målblodtryck inom tre månader vilket räddar liv.Behandlingsmål för de allra flesta är <130/80 mm Hg (hemblodtryck, mottagningsblodtryck eller dagmedelvärde på 24-timmarsmätning). Anpassa blodtrycksmål vid ålder ≥85 år, skörhet, ortostatiska besvär och/eller intolerans. För aktuella regionala behandlingsmål, se Hypertoni; viss.nu.Inled behandling tidigt, utvärdera efter 4 veckor och sträva efter att uppnå blodtrycksmål inom 3 månader. Detta är särskilt viktigt för patienter med hög – mycket hög kardiovaskulär risk.Hypertoni; viss.nu För behandling av hypertoni vid graviditet och amning, se Hypertoni; viss.nu.ACE-HÄMMAREenalaprilEnalapril …, RenitecramiprilRamipril …ANGIOTENSINRECEPTORBLOCKERARE (ARB)kandesartanCandesartan ..., Candesarstad, Candexetil, Kairasec, KandrozidlosartanLosartan …Hypertoni vid diabetes mellitus bör behandlas med ACE-hämmare eller ARB.KALCIUMANTAGONISTamlodipinAmlodipin …, Amlodistad, NorvascDIURETIKAbendroflumetiazidBendroflumetiazid …, SalureshydroklortiazidHydroklortiazid ..., Esidrexhydroklortiazid +amiloridAmiloferm mite, Normorix mitehydroklortiazid +amiloridAmiloferm, NormorixBeakta risk för hypokalemi och hyponatremi. KOMBINATIONERACE-hämmare eller ARB i kombination med amlodipin och/eller diuretikum rekommenderas.Fasta kombinationspreparatenalapril +hydroklortiazidEnalapril/Hydrochlorothiazide ..., Enalapril comp ..., Linatil comp, Renitec compkandesartan +hydroklortiazidCandesartan/Hydrochlorothiazide ..., Atacand Plus, Candemox Comp, Candesarstad Comp, Candexetil comp, Etilbolosartan +hydroklortiazidLosartan/Hydrochlorothiazide …, Losarstad Comp, MarozidTilläggsbehandlingMINERALKORTIKOIDRECEPTORANTAGONIST (MRA)spironolaktonSpironolakton …Spironolakton är mer effektivt än övriga tilläggsmedel vid behandling av terapiresistent hypertoni. ALFABLOCKERAREdoxazosinDoxazosin …, Alfadil*, Cardura*, Carduran**Begränsad subvention; tlv.seBETABLOCKERAREmetoprololsuccinatMetoprolol …, Bloxazoc, Metomylan, SelokenZOCBetablockerare ges som tilläggsbehandling vid hypertoni eller vid samtidig ischemisk hjärtsjukdom, rytmrubbningar, hjärtsvikt eller migrän. Specialiserad vårdALFA- OCH BETABLOCKERARElabetalolTrandate**Ingår inte i läkemedelsförmånen. Fri prissättning gör att priset kan variera på olika apotek.Ischemisk hjärtsjukdomTROMBOCYTHÄMMAREacetylsalicylsyraAcetylsalicylsyra …, Trombyl 75 mg/dygnVid misstanke om instabil kranskärlssjukdom ges en laddningsdos om 500 mg helst buffrad acetylsalicylsyra, t.ex. Bamyl brustablett. Alternativt tuggas 4 tabletter Trombyl (totaldos 300 mg) för snabb effekt.klopidogrelClopidogrel ..., Cloriocard, Grepid, PlavixKlopidogrel är alternativ vid ASA-överkänslighet.Vid tidigare ulkussjukdom är det säkrare att lägga till PPI till ASA än att byta till klopidogrel. Specialiserad vårdTROMBOCYTHÄMMAREprasugrelPrasugrel ..., EfienttikagrelorBriliquePrasugrel eller tikagrelor ges som tidsbegränsad kombinationsbehandling med ASA efter akut koronart syndrom. Klopidogrel är ett alternativ till prasugrel eller tikagrelor som tidsbegränsat tillägg till ASA för vissa patientgrupper efter hjärtinfarkt eller PCI. ÖVRIGA ANTITROMBOTISKA LÄKEMEDELfondaparinuxArixtraheparinnatriumHeparin LEOLipidsänkande behandlingLäs mer, sid xxBETABLOCKERAREmetoprololsuccinatMetoprolol …, Bloxazoc, Metomylan, SelokenZOC 100–200 mg/dygnACE-HÄMMAREVid nedsatt vänsterkammarfunktion, diabetes mellitus eller hypertoniramiprilRamipril ... måldos 10 mg/dygnMåldosen har visats minska sjuklighet och bör eftersträvas om patienten tolererar denna.MINERALKORTIKOIDRECEPTORANTAGONIST (MRA)Vid hjärtsvikt efter hjärtinfarkt övervägeplerenonóEplerenon …, Inspra 50 mg/dygnspironolakton*óSpironolakton … 25–50 mg/dygnBeakta risk för hyperkalemi (lätt förhöjt och stabilt P-Kalium upp till 5,5 mmol/l kan ofta tolereras). *Risk för gynekomasti som är reversibel vid kortare tids användning. Vid diabetes mellitus typ 2SGLT2-hämmare och/eller GLP-1-analoger rekommenderas, se Aterosklerotisk hjärt-kärlsjukdom och samtidig diabetes mellitus typ 2 och/eller kronisk njursjukdom sid xxSe även Aterosklerotisk hjärt-kärlsjukdom under Diabetes mellitus typ 2 sid xxAngina pectoris – symtomatisk behandlingAnfallskuperandeNITROGLYCERINglyceryltrinitratGlytrin, Nitrolingual sprayglyceryltrinitratSuscard buckaltablettAnfallsförebyggandeBETABLOCKERAREbisoprololBisoprolol …, Bisomyl, Bisostad, Emconcor CHFmetoprololsuccinatMetoprolol …, Bloxazoc, Metomylan, SelokenZOCKALCIUMANTAGONISTERamlodipinAmlodipin …, Amlodistad, NorvascverapamilIsoptin Retard*Försiktighet med verapamil i kombination med betablockad på grund av risk för bradyarytmier*Begränsad subvention; tlv.seLÅNGVERKANDE NITRATisosorbidmononitratImdur, IsomexHjärtsviktDiagnosen hjärtsvikt ställs utifrån symtom, statusfynd, EKG, natriuretiska peptider och ekokardiografiska fynd. Behandlingsrekommendationen delas in i tre avsnitt beroende på vänsterkammarens ejektionsfraktion (EF). I regel bör insatt hjärtsviktsbehandling vid nedsatt vänsterkammarfunktion fortsätta även om EF har normaliserats. Hjärtsvikt med bevarad systolisk vänsterkammarfunktion (EF ≥50%)Heart Failure with preserved ejection fraction, HFpEFBehandling av underliggande hjärt-kärlsjukdom (t.ex. hypertoni, ischemisk hjärtsjukdom, förmaksflimmer) och komorbiditet (t.ex. diabetes, njursvikt, lungsjukdom, övervikt, anemi) kan påverka förloppet positivt. SGLT2-hämmare har visat minskad risk för sjukhusinläggning på grund av hjärtsvikt. Diuretika ges vid symtom eller tecken på övervätskning. Hjärtsvikt med lätt nedsatt systolisk vänsterkammarfunktion (EF 41–49%)Heart Failure with mildly reduced ejection fraction, HFmrEFHFmrEF betraktas som en form av nedsatt systolisk vänsterkammarfunktion varför samtliga basläkemedel som rekommenderas vid HFrEF ska övervägas. Hjärtsvikt med nedsatt systolisk vänsterkammarfunktion (EF ≤40%)Heart Failure with reduced ejection fraction, HFrEF Sätt in och följ upp alla fyra basläkemedel vid HFrEF för att minska dödlighet och hjärtsviktssymtom.Patienter med HFrEF ska erbjudas behandling med samtliga fyra basläkemedel. SGLT2-hämmare rekommenderas oavsett förekomst av diabetes mellitus typ 2 och kan oftast sättas in utan att justera övriga läkemedel. Vid nyupptäckt hjärtsvikt (HFrEF) påbörjas behandling med basläkemedel och remiss skickas till hjärtsviktsmottagning. En snar insättning av samtliga fyra basläkemedel rekommenderas. Ordningsföljden vid insättning kan väljas utifrån patientens sjukdomsprofil, se Läkemedelsbehandling vid kronisk hjärtsvikt nedan. Titrera därefter om möjligt till måldoser. Utöver detta ges diuretika vid behov och dosen bör justeras utifrån symtom och ”torrvikt”. Uppmuntra patientens delaktighet i diuretikadoseringen. Se Diuretikabehandling vid hjärtsvikt; janusinfo.se. Remiss till hjärtsviktsmottagning på sjukhus bör utnyttjas för hjälp med diagnostik, dostitrering och information. Efter optimering av läkemedelsbehandlingen görs en ny evaluering av hjärtfunktionen. Vid fortsatt symtomatisk hjärtsvikt med EF ≤40% bör remiss skickas för ställningstagande till specialiserad tilläggsbehandling.Hjärtsvikt; viss.nu Läkemedelsbehandling vid kronisk hjärtsvikt; se LOK på samverkanlakemedel.se.Läkemedel vid hjärtsviktACE-HÄMMAREenalaprilEnalapril …, Renitec måldos (20–) 40 mg/dygnramiprilRamipril … måldos 10 mg/dygnMåldosen bör eftersträvas om patienten tolererar denna. Vid ACE-hämmarintoleransANGIOTENSINRECEPTORBLOCKERARE (ARB)kandesartanCandesartan ..., Candesarstad, Candexetil, Kairasec, Kandrozid måldos 32 mg/dygnlosartanLosartan … måldos 150 mg/dygnMåldosen bör eftersträvas om patienten tolererar denna. Vid nyinsättning av ARB vid hjärtsvikt rekommenderas kandesartan. BETABLOCKERAREbisoprololBisoprolol …, Bisomyl, Bisostad, Emconcor CHF måldos 10 mg/dygnmetoprololsuccinatMetoprolol …, Bloxazoc, Metomylan, SelokenZOC måldos 200 mg/dygnMåldosen bör eftersträvas om patienten tolererar denna.MINERALKORTIKOIDRECEPTORANTAGONIST (MRA)eplerenonEplerenon …, Inspra 50 mg/dygnspironolakton*Spironolakton … 25–50 mg/dygnBeakta risk för hyperkalemi (lätt förhöjt och stabilt P-Kalium upp till 5,5 mmol/l kan ofta tolereras). *Risk för gynekomasti som är reversibel vid kortare tids användning.SGLT2-HÄMMAREdapagliflozinForxiga* 10 mgempagliflozinJardiance* 10 mg*Begränsad subvention; tlv.seObservera risk för ketoacidos även vid normala blodsockervärden. Gör behandlingsuppehåll vid akut sjukdom, vätskebrist och fasta. Patientinformation finns för utskrift på janusinfo.se. Den blodsockersänkande effekten av SGLT2-hämmare avtar med minskande njurfunktion, och är låg vid eGFR <45 ml/min. Kardiovaskulär- och njurskyddande effekt finns även vid lägre eGFR. Kan nyinsättas ned till eGFR 20 ml/min. Se Njursjukdomar sid xx.SGLT2-hämmare ska inte användas hos patienter med diabetes mellitus typ 1.Se även SGLT2-hämmare vid diabetes mellitus typ 2, hjärt- kärl- eller njursjukdom; janusinfo.se. Specialiserad vårdFör patienter med symtomatisk hjärtsvikt och nedsatt EF (<50%) trots optimal behandling enligt ovanANGIOTENSINRECEPTOR-NEPRILYSINHÄMMARE (ARNI)sakubitril +valsartanEntresto*Sakubitril + valsartan ska följas upp på samma sätt som annan behandling med RAAS-blockerare. Observera att läkemedlet inte ska kombineras med ACE-hämmare.*Begränsad subvention; tlv.seSymtomatisk hjärtsviktsbehandlingDIURETIKAbendroflumetiazidBendroflumetiazid …, SaluresfurosemidFurosemid …, Furix, Impugan, MindumhydroklortiazidHydroklortiazid ..., EsidrexTiazider har sämre effekt vid nedsatt njurfunktion. Ska inte användas vid eGFR <30 ml/min.Observera att furosemid ofta behöver dosökas vid försämrad njurfunktion. Monitorera effekten.Vid hypokalemiI första handeplerenonEplerenon …, Inspra 50 mg/dygnspironolakton*Spironolakton … 25–50 mg/dygn*Risk för gynekomasti som är reversibel vid kortare tids användning. I andra handkaliumkloridKaliumklorid …, KaleoridVid järnbrist med eller utan anemijärnkarboximaltosFerinject*Järnbehandling ska övervägas vid S-ferritin <100 mikrog/l eller vid S-ferritin 100–299 mikrog/l och Ptransferrinmättnad <0,2 (20%). Gäller för patienter med symtomatisk hjärtsvikt och nedsatt EF (<50%).*Begränsad subvention; tlv.seVid förmaksflimmer eller som symtomatisk tilläggsbehandling vid svår hjärtsviktÖvervägdigoxinDigoxin EvolanSka användas i låg dos. Kontrollera plasmakoncentrationen vid behov. Kvinnor har högre risk för förhöjd koncentration.Förmaksflimmer, förmaksfladderTa ställning till tromboemboliprofylax med antikoagulantia, se sid xx. Valet mellan frekvensreglerande och rytmreglerande strategi styrs huvudsakligen av patientens symtom. Behandla bakomliggande sjukdomar och riskfaktorer som hypertoni, hjärtsvikt, övervikt, hög alkoholkonsumtion och obstruktiv sömnapné.FrekvensregleringGod frekvensreglering är viktigt vid förmaksflimmer/-fladder. I första handbisoprololBisoprolol …, Bisomyl, Bisostad, Emconcor CHFmetoprololsuccinatMetoprolol …, Bloxazoc, Metomylan, SelokenZOCI andra hand verapamilIsoptin Retard* (i tvådos)Som alternativ, till exempel vid intolerans mot betablockerare. Kontraindicerat vid hjärtsvikt med EF ≤40%.Vid otillräcklig frekvensreglering, överväg tillägg avdigoxinDigoxin EvolanverapamilIsoptin Retard* (i tvådos)Kontrollera plasmakoncentration av digoxin vid behov, speciellt vid nedsatt njurfunktion. Kvinnor har högre risk för förhöjd koncentration av digoxin.Det kan finnas skäl att kombinera betablockerare med digoxin eller verapamil för att åstadkomma en bättre frekvensreglering. Vid kombinationsbehandling bör risk för bradykardi beaktas. Rådgör med kardiologi/internmedicin vid osäkerhet. *Begränsad subvention; tlv.seRytmregleringVid symtomatiskt förmaksflimmer/-fladder bör elkonvertering, antiarytmika och ablation övervägas. Dessa behandlingar styrs via specialistvården och ska helst initieras tidigt i sjukdomsförloppet. Antiarytmiska läkemedel kan ge allvarliga biverkningar. Beakta läkemedelsinteraktioner och tillkomst av kontraindikationer under pågående behandling (t.ex. hjärtsvikt, ischemisk hjärtsjukdom, njursvikt, QT-förlängning). Sätt ut antiarytmika vid permanent/kroniskt flimmer/fladder.Ablation rekommenderas vid symtomatiskt förmaksflimmer som inte svarar på antiarytmika men kan även övervägas som förstahandsbehandling. Ablation är förstahandsval vid recidiv av symtomatiskt förmaksfladder.Specialiserad vårdANTIARYTMIKAI första handdronedaronDronedaron ...*, Multaq*flekainidTambocorDronedaron interagerar bland annat med orala antikoagulantia. Flekainid bör vanligen kombineras med betablockerare. *Begränsad subvention; tlv.seI andra hand – vid strukturell hjärtsjukdomamiodaronAmiodaron …, Cordarone tablettamiodaron injAmiodaron hamelnAmiodaron interagerar bland annat med orala antikoagulantia.TromboemboliprofylaxAnvänd riskskattning med CHA2DS2-VA för ställningstagande till antitrombotisk behandling. CHA2DS2-VA ≥2 innebär indikation för antikoagulantiabehandling. Vid CHA2DS2-VA =1 överväg antikoagulantiabehandling, framför allt vid ålder över 65 år. Risken för tromboembolism ökar kontinuerligt med stigande ålder. Åtgärda påverkbara riskfaktorer för blödning såsom högt blodtryck och överkonsumtion av alkohol. Undvik preparat som ökar blödningsrisken, t.ex. COX-hämmare, SSRI och omega-3-fettsyror. Hos sköra äldre patienter med hög blödningsrisk måste en klinisk bedömning göras angående nyttan av behandlingen. Perorala antikoagulantiaSamtliga perorala antikoagulantia ställer särskilda krav på patientinformation och systematisk uppföljning med kontroll av compliance, njurfunktion, Hb, eventuella interaktioner med andra läkemedel samt blödningsrisken. Direktverkande orala antikoagulantia (DOAK/NOAK) är kontraindicerade vid mekanisk hjärtklaff och vid signifikant mitralisstenos.Patienten ska förses med antikoagulantiabricka och varning ska noteras i den elektroniska journalen.Beprövade reverseringsrutiner finns för warfarin och för dabigatran finns en specifik antidot (idarucizumab) sid xx. Den antikoagulativa effekten av warfarin eller faktor Xa-hämmare kan motverkas med protrombinkomplexkoncentrat (PCC) sid xx. För samtliga DOAK finns möjlighet att mäta plasmakoncentrationer.I första handDIREKTVERKANDE FAKTOR Xa-HÄMMARE (DOAK)apixabanEliquisApixaban är minst njurfunktionsberoende för sin eliminering bland aktuella DOAK. Vid eGFR <15 ml/min, diskutera med njurspecialist. I andra handDIREKTVERKANDE TROMBINHÄMMARE (DOAK)dabigatranDabigatran …, PradaxaDabigatran är ett alternativ till apixaban till exempel vid risk för betydelsefulla läkemedelsinteraktioner via cytokrom P450. Var försiktig hos äldre patienter med nedsatt njurfunktion. Dabigatran är kontraindicerat vid eGFR <30 ml/min. Undvik dabigatran vid BMI över 40 eller vikt över 120 kg. ANTIVITAMIN K-LÄKEMEDELwarfarinWaran* innehåller blått färgämne, indigokarminwarfarinWarfarin Orion*Ingår inte i läkemedelsförmånen. Fri prissättning gör att priset kan variera mellan olika apotek.Observera att warfarin ska användas för patienter med mekanisk klaff eller signifikant mitralisstenos.En välfungerande warfarinbehandling hos sköra äldre behöver ej bytas till DOAK.Av säkerhetsskäl rekommenderas särskild dosett för vita warfarintabletter. PK-INR målvärde: mellan 2,0 och 3,0. För vissa patienter kan självtestning och eventuellt egen dosjustering vara aktuellt.Självtestning och egenvård vid warfarinbehandling; viss.nuLathund 2025 Antikoagulantiabehandling vid förmaksflimmer; janusinfo.se Orala antitrombotiska läkemedel vid blödning och inför kirurgi hos vuxna; janusinfo.se Klaffsjukdom och medfödda vitierEndokarditprofylax sid xxAntikoagulantiabehandling med AVK och LMH; viss.nu Warfarin är det antikoagulantium som ska användas av patienter med mekanisk klaff.Perifer artärsjukdomPerifer artärsjukdom innebär kraftigt ökad risk för kardiovaskulära händelser. Med perifer artärsjukdom avses bland annat aterosklerotisk benartärsjukdom (symtomgivande claudicatio och/eller ankel/brakialindex <0,9) och karotissjukdom.Identifiera perifer artärsjukdom genom att fråga efter symtom och mäta ankel/brakialindex; instruktionsfilm på janusinfo.seBenartärsjukdom – kritisk ischemi och claudicatio; viss.nuUppmärksamma kritisk ischemi med vilovärk/sår/gangrän och handlägg skyndsamt, se vårdförlopp Kritisk benischemi; vardpersonal.1177.se.Hälsosamma levnadsvanorGångträning vid benartärsjukdom, helst ledarledd. Rekommendation enligt eFyss. Överväg FaR. Tobaksstopp är särskilt viktigt, erbjud stödjande insatser. Läs om Nikotinberoende sid xx.Lipidsänkande behandlingLäs mer, sid xxDessa patienter har mycket hög kardiovaskulär risk och ska erbjudas lipidsänkande behandling.Blodtryckssänkande behandling Läs mer, sid xxVid perifer artärsjukdom gäller samma behandlingsstrategi och blodtrycksmål som för övriga patienter med hypertoni, sid xx, undantaget vid kritisk ischemi. Vid perifer artärsjukdom ska ACE-hämmare eller ARB övervägas som förstahandsmedel.Vid diabetes mellitus typ 2Det är viktigt med blodsockerreglering, se Diabetes mellitus typ 2 sid xx.SGLT2-hämmare och/eller GLP-1-analoger rekommenderas, se Aterosklerotisk hjärt-kärlsjukdom och samtidig diabetes mellitus typ 2 och/eller kronisk njursjukdom sid xx.Trombocythämmande läkemedelTill samtliga patienter med symtomatisk perifer artärsjukdomTROMBOCYTHÄMMAREacetylsalicylsyraAcetylsalicylsyra …, Trombyl 75 mg/dygnellerklopidogrelClopidogrel ..., Cloriocard, Grepid, Plavix Specialiserad vårdKombinationsbehandling (dubbel trombocythämning eller acetylsalicylsyra i lågdos i kombination med rivaroxaban i lågdos), kan sättas in av kärlkirurg eller kardiolog/internmedicinare efter särskild bedömning eller intervention. Instruktion om behandlingslängd (ofta tidsbegränsad) och lämplig uppföljning ska finnas.DIREKTVERKANDE FAKTOR Xa-HÄMMARErivaroxaban Rivaroxaban …, Xarelto 2,5 mg Lågdos rivaroxaban 2,5 mg x 2 i kombination med acetylsalicylsyra 75 mg x 1 ska övervägas efter endovaskulär eller kirurgisk intervention av benartärsjukdom hos patienter utan förhöjd blödningsrisk. Sådan behandling ska också övervägas till patienter utan förhöjd blödningsrisk vid perifer artärsjukdom med viss samsjuklighet (t.ex. hjärtsvikt, diabetes, polyvaskulär sjukdom).Venös tromboembolisk sjukdom (VTE)Hälsosamma levnadsvanorÖvervikt är en riskfaktor både för insjuknande i och recidiv av VTE.Alkohol i samband med antikoagulantiabehandling kan bidra till ökad blödningsrisk.Läs om Hälsosamma levnadsvanor sid xx Trombosprofylax vid kirurgi och tillfällig immobilisering på grund av sjukdom eller traumaLÅGMOLEKYLÄRA HEPARINERdalteparinFragmintinzaparinInnohepVid elektiv höft- och knäplastikDIREKTVERKANDE FAKTOR Xa-HÄMMAREapixabanEliquisBör undvikas vid eGFR <15 ml/min och användas med försiktighet vid eGFR 15–29 ml/min.Behandling av venös tromboembolisk sjukdom Inled alltid behandling med antikoagulantia vid stark misstanke om akut trombos. Vid val av antikoagulantia rekommenderas aktuell blödningsanamnes och genomgång av eventuella läkemedelsinteraktioner.Vid kroppsvikt under 50 kg, över 120 kg eller BMI ≥40, se Dosering av antikoagulantia vid venös tromboembolism hos patienter med över- eller undervikt; janusinfo.se.Uppföljande läkarbesök inom 3 månader rekommenderas för utvärdering av antikoagulantiabehandling, ställningstagande till kompletterande utredning, beslut om behandlingstidens längd och eventuell dosreduktion.Patienter med antikoagulantiabehandling rekommenderas årlig omprövning med kontroll av blödningskomplikationer, blodtryck, blodstatus och njurfunktion. Fysisk aktivitet underlättar återhämtning och tillfrisknande.I första handDIREKTVERKANDE FAKTOR Xa-HÄMMAREapixabanEliquisBör undvikas vid eGFR <15 ml/min och användas med försiktighet vid eGFR 15–29 ml/min. Gravida/ammande samt patienter med antifosfolipidsyndrom ska inte behandlas med apixaban.I andra handDIREKTVERKANDE TROMBINHÄMMAREdabigatranDabigatran …, PradaxaAlternativ till apixaban vid biverkningar och/eller risk för betydelsefulla läkemedelsinteraktioner.Vid akut insjuknande ska lågmolekylärt heparin ges i behandlingsdos i 5 dagar innan dabigatran sätts in. Dabigatran är kontraindicerat vid eGFR <30 ml/min. Ska inte användas hos gravida/ammande samt vid antifosfolipidsyndrom. Undvik dabigatran vid BMI över 40 eller vikt över 120 kg. Behandling vid VTE när DOAK inte rekommenderas LÅGMOLEKYLÄRA HEPARINERdalteparinFragmintinzaparinInnohepANTIVITAMIN K-LÄKEMEDELwarfarinWaran* innehåller blått färgämne, indigokarminwarfarinWarfarin Orion*Ingår inte i läkemedelsförmånen. Fri prissättning gör att priset kan variera mellan olika apotek.Warfarin ska inte användas under graviditet.Vid insättning av warfarin vid VTE krävs parallell behandling med lågmolekylärt heparin i behandlingsdos i minst 5 dagar och tills terapeutiskt PK(INR) 2,0–3,0. Av säkerhetsskäl rekommenderas särskild dosett för vita warfarintabletter för att särskilja dessa från andra tabletter.Självtestning och egenvård vid warfarinbehandling; viss.nuOrala antitrombotiska läkemedel vid blödning och inför kirurgi hos vuxna; janusinfo.se Djup ventrombos; viss.nuLungemboli; viss.nuSpecialiserad vårdCancerassocierad trombos Cancerassocierad venös tromboembolism; janusinfo.seVenös trombos/lungemboli; kunskapsbanken.cancercentrum.seI första handDIREKTVERKANDE FAKTOR Xa-HÄMMAREapixabanEliquisedoxaban*Lixiana*Vid akut insjuknande ska lågmolekylärt heparin ges i behandlingsdos i 5 dagar innan edoxaban sätts in. Interaktionsrisk kan föreligga med antitumorala läkemedel som påverkar CYP3A4- och P-gp-aktivitet. Edoxaban har lägst interaktionsrisk.I andra handLÅGMOLEKYLÄRA HEPARINERdalteparinFragmintinzaparinInnohepÖvriga antitrombotiska medelOFRAKTIONERAT HEPARINheparinnatriumHeparin LEOPENTASACKARIDfondaparinuxArixtraTROMBOLYTISKT/FIBRINOLYTISKT VERKANDE LÄKEMEDELalteplasActilyseYtlig venös trombos (tromboflebit)Utredning och behandling av ytlig venös trombos (tromboflebit); janusinfo.seLokalbehandlingGes som monoterapi eller tillsammans med systemisk behandling. God smärtstillande och antiinflammatorisk effekt.ORGANISK HEPARINOIDglukosaminoglykanpolysulfatHirudoid**Ingår inte i läkemedelsförmånen. Fri prissättning gör att priset kan variera mellan olika apotek.Systemisk behandlingI första handPENTASACKARIDfondaparinuxArixtraI andra handLÅGMOLEKYLÄRA HEPARINERdalteparinFragmintinzaparinInnohepHemostatiskt verkande läkemedelK-VITAMINfytomenadionKonakion Novum injFör användning av Konakion Novum, se Antikoagulantiabehandling med AVK och LMH; viss.nu.FIBRINOLYSHÄMMANDE LÄKEMEDELtranexamsyraTranexamsyra …, Cyklokapron, Cyklonova, Tranexa tabletttranexamsyraCyklokapron brustablettSpecialiserad vårdLÄKEMEDEL SOM FRISÄTTER KOAGULATIONSFAKTOR VIII OCH VON WILLEBRAND-FAKTOR desmopressin injOctostimFIBRINOLYSHÄMMANDE LÄKEMEDELtranexamsyra injPilexamPROTROMBINKOMPLEXKONCENTRATkoagulationsfaktorer II, VII, IX, XConfidexProtrombinkomplexkoncentrat är förstahandsalternativ vid allvarlig blödning under warfarinbehandling och ges tillsammans med Konakion Novum. Protrombinkomplexkoncentrat används också i vissa fall med allvarlig blödning hos patienter som behandlas med faktor Xa-hämmare.Vid blödning under behandling med andra antikoagulantia, se Orala antitrombotiska läkemedel vid blödning och inför kirurgi hos vuxna; janusinfo.se. ANTIDOT TILL DABIGATRANidarucizumabPraxbindUpprepad dos kan behövas.Specialiserad vårdHemofili Aefmoroktokog alfaEloctaiVBORw0KGgoAAAANSUhEUgAAAvMAAAEOCAIAAACLgw/aAAAACXBIWXMAAAsSAAALEgHS3X78AAAg
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