Stellenwert niedermolekularer Heparine in der Therapie akuter koronarer Syndrome

Die Therapie akuter koronarer Syndrome - instabile Angina pectoris und akuter Herzinfarkt - hat sich in den letzten Jahren durch aktuelle Studienergebnisse verändert. Diese Veränderungen beruhen zum einen auf pharmakologischen Neuerungen wie der Plättcheninhibitortherapie mit Clopidogrel und Glykoprotein IIb/IIIa-Antagonisten. Zum anderen hat die Troponinbestimmung zu einer besseren Risikostratifizierung des Patienten mit akutem koronaren Syndrom geführt, so dass Entscheidungen über ein frühes invasives oder konservatives Vorgehen in der Akutsituation möglich sind. Während sich die direkten Thrombininhibitoren in dieser klinischen Situation nicht haben etablieren können, kommt der antithrombotischen Therapie mit niedermolekularen Heparinen (LMWH) als Ersatz für das seit Jahrzehnten verwendete unfraktionierte Heparin (UFH) große Bedeutung zu. Im Folgenden wird der Stellenwert der LMWH in der Therapie akuter koronarer Syndrome vor dem Hintergrund aktueller Studienergebnisse dargestellt.

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