Aktuelle Kardiologie 2012; 1(1): 44-48
DOI: 10.1055/s-0031-1298298
Übersichtsarbeit
Georg Thieme Verlag KG Stuttgart · New York

Welche Thrombozytenaggregationshemmung für wen?

Which Antiplatelet Therapy for Whom?
D. Duerschmied
1   Innere Medizin III, Kardiologie/Angiologie, Universitätsklinikum Freiburg
,
C. Bode
1   Innere Medizin III, Kardiologie/Angiologie, Universitätsklinikum Freiburg
,
M. Moser
1   Innere Medizin III, Kardiologie/Angiologie, Universitätsklinikum Freiburg
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
30. März 2012 (online)

Zusammenfassung

Die Behandlung von Patienten mit koronarer Herzerkrankung wurde durch die perkutane Koronarintervention (PCI) revolutioniert. Weil hierdurch aber auch Gefäßwandschäden induziert werden und eine Fremdoberfläche eingebracht wird, ist eine effektive Plättchenhemmung unverzichtbar. Im letzten Jahr haben 2 neue ADP-Inhibitoren, Prasugrel und Ticagrelor, Einzug in die klinische Praxis gehalten. Neue Leitlinien liefern Entscheidungshilfen zum Einsatz dieser Substanzen. Während Clopidogrel der wichtigste ADP-Inhibitor bei Patienten mit elektiver PCI bei stabiler koronarer Herzerkrankung bleibt, sollten im akuten Koronarsyndrom die neuen ADP-Inhibitoren bevorzugt werden. Patienten, die zusätzlich eine plasmatische Antikoagulation benötigen, stellen eine besondere Herausforderung dar und benötigen eine differenzierte Dreifachtherapie.

Abstract

Percutaneous coronary intervention (PCI) revolutionized the management of patients with coronary artery disease, but has to be accompanied by effective (dual) antiplatelet therapy. Two novel ADP inhibitors have recently entered clinical practice as combination partners for aspirin, prasugrel and ticagrelor. International societies have already established guidelines to facilitate daily practice. While clopidogrel remains the key ADP inhibitor in patients with stable coronary artery disease undergoing elective PCI, the novel substances are preferred for patients with acute coronary syndrome. Treatment of patients requiring additional plasmatic anticoagulation is particularly challenging and involves a differentiated triple antithrombotic approach.

 
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