Duale antithrombozytäre Therapie – Perioperativ absetzen oder weiterführen?

Zusammenfassung

Hintergrund Bei Patienten nach akutem Koronarsyndrom wird die duale antithrombozytäre Therapie (DAPT) mit Acetylsalicylsäure und einem P2Y₁₂-Adenosindiphosphat-Rezeptorblocker wie Clopidogrel, Prasugrel und Ticagrelor für eine Dauer von 12 Monaten in den Leitlinien empfohlen. Wenn diese Hochrisikopatienten sich einem chirurgischen Eingriff unterziehen müssen, herrscht oft Unsicherheit bezüglich der DAPT: Kann die Therapie ohne Unterbrechung fortgeführt werden? Wenn nein, welches Therapie-Karenzkonzept wird empfohlen? Was muss beim perioperativen Management beachtet werden?

Methoden Eine interdisziplinäre Gruppe erfahrener Experten aus den Bereichen Kardiologie, Kardiochirurgie, Gastroenterologie, Anästhesiologie, Intensivmedizin und Hämostaseologie hat auf Basis der aktuellen wissenschaftlichen Datenlage praxisrelevante Informationen und Empfehlungen erarbeitet.

Ergebnisse Die Empfehlungen schließen Hinweise für die Einschätzung des Patienten- und Operations-spezifischen Blutungs- und Ischämierisikos, generelle Hinweise bezüglich des Karenzkonzeptes der DAPT und konkrete Empfehlungen hinsichtlich Thrombozytenfunktionshemmung bei häufigen chirurgischen Eingriffen ein.

Diskussion Diese Zusammenstellung soll allen beteiligten medizinischen Disziplinen den Umgang mit Patienten unter DAPT erleichtern und damit eine optimale perioperative Versorgung der Patienten gewährleisten.

Abstract

Background For secondary prevention of acute coronary syndrome, guidelines recommend dual antiplatelet therapy (DAPT) with acetylsalicylic acid and a P2Y12 receptor antagonist such as clopidogrel, prasugrel or ticagrelor for a period of 12 months. Often, uncertainty exists with respect to surgical or diagnostic procedures in these high-risk patients: can the DAPT be continued without interruption? If not, what is the recommended withdrawal strategy? What should be considered for the perioperative management?

Methods An interdisciplinary group of experienced experts in the fields of cardiology, cardiac surgery, gastroenterology, anaesthesiology, intensive care and haemostaseology developed recommendations relevant to daily clinical practice based on the current scientific evidence.

Results These recommendations include instructions for evaluating the patient- and procedure-specific risks of bleeding and ischaemia, general recommendations regarding the DAPT withdrawal strategy, and specific guidance for frequent surgical or diagnostic procedures.

Discussion This article aims to facilitate the management of patients with DAPT for all medical disciplines involved, thereby ensuring optimal care of patients during the perioperative period.

Schlüsselwörter

ADP-Rezeptorblocker - Akutes Koronarsyndrom (ACS) - Duale Plättchenhemmung (DAPT) - Perioperatives Blutungsrisiko - Perioperatives Thromboserisiko - Perioperatives Management

Key words

acute coronary syndrome - dual antiplatelet therapy - perioperative - periinterventional - hemorrhage - purinergic P2Y receptor antagonist

^* Geteilte Erstautorenschaft.

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