Ist die Antiaggregation mit Thrombozytenfunktionshemmern bei asymptomatischen atherosklerotischen Plaques zur Prophylaxe indiziert?

Zusammenfassung

Hintergrund

Die Antiaggregation mit Thrombozytenfunktionshemmern (TFH) ist fester Bestandteil in der Sekundärprävention bei Patienten mit manifesten atherosklerotischen Gefäßerkrankungen. Die Rolle von TFH in der Primärprävention ist umstritten. Die Leitlinien zur peripheren arteriellen Verschlusskrankheit (PAVK) und zur Carotisstenose empfehlen, dass Patienten, die klinisch asymptomatisch sind, keine TFH einnehmen sollen. Die Datenlage, die dieser Entscheidung zu Grunde liegt, hat jedoch einen niedrigen Evidenzgrad und andere internationale Leitlinien empfehlen die Gabe von TFH bei allen Patienten mit Nachweis von Plaques in der Carotis.

Schlussfolgerungen

Die vorliegende Analyse der Literatur zeigt, dass die pauschale Aussage, dass Patienten mit asymptomatischer Atherosklerose der Carotis (Stenosegrad <50%) und pAVK keine prophylaktische TFH benötigen, weder das Ausmaß noch die Morphologie der Atherosklerose berücksichtigt. Die Indikation zur TFH-Gabe bei asymptomatischer Atherosklerose sollte stets individuell gestellt werden und dabei sowohl das Ausmaß der Atherosklerose als auch das persönliche Blutungs- und Ischämierisiko einbeziehen.

Abstract

Background

Antiaggregation with platelet function inhibitors (PFI) is an integral part of secondary prevention in patients with clinically manifest atherosclerotic vascular disease. The role of PFI in primary prevention is controversial. The current guidelines on peripheral arterial disease (PAD) and carotid stenosis recommend that patients who are clinically asymptomatic regarding vascular disease should not take PFI. However, the data on which this decision is based has a low level of evidence, and other international guidelines recommend antiaggregation in any case of plaques in the carotid.

Conclusions

The present analysis of the literature shows that the blanket statement that patients with asymptomatic carotid atherosclerosis (stenosis degree <50%) and PAD do not require prophylactic PFI neither considers the extent nor the morphology of the underlying atherosclerosis. The indication for PFI in patients with asymptomatic atherosclerosis should always be determined individually, considering both the extent of the atherosclerosis and the personal risk of bleeding and ischemia.

Schlüsselwörter

asymptomatische Atherosklerose - periphere arterielle Verschlusskrankheit - Carotisstenose - Thrombozytenfunktionshemmer

Keywords

asymptomatic atherosclerosis - peripheral arterial disease - carotid stenosis - platelet function inhibitors

• Literatur

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