Antithrombotische Therapie beim akuten Koronarsyndrom

Die duale antithrombozytäre Therapie (DAPT) ist ein Eckpfeiler der Nachbehandlung interventionell versorgter Patienten nach einem akuten Koronarsyndrom. Besonderes Augenmerk gilt all jenen Patienten, die z.B. aufgrund von Vorhofflimmern antikoaguliert werden und zusätzlich eine Thrombozytenhemmung nach Stentimplantation benötigen. Im vorliegenden Artikel werden die Bewertungen der aktuellen Leitlinie zusammenfassend dargestellt.

Abstract

Dual antiplatelet therapy (DAPT) is the cornerstone of maintenance medication following acute coronary syndromes (ST elevation myocardial infarction, non-ST elevation myocardial infarction, unstable angina). Over the last decade, P2Y12 inhibition in addition to low-dose acetylsalicylic acid has been intensively debated. In patients with acute coronary syndromes, balancing the reduction in cardiovascular events and increase in major bleeding during treatment with more potent P2Y12 inhibitors such as prasugrel and ticagrelor is still an issue. A special focus is on patients already treated with oral anticoagulants for stroke prevention in atrial fibrillation who require additional platelet inhibition following coronary stenting. This article summarizes the major recommendations given in the most recent Guideline for “Acute Coronary Syndromes” published by the European Society of Cardiology (ESC). The recommendations finally address strategies to reduce an increased bleeding risk based on clinical predictors.

Schlüsselwörter

duale antithrombozytäre Therapie - P2Y12-Blocker - Antikoagulation - Koronarintervention

Keywords

dual anti-platelet treatment - P2Y12 blocker - anticoagulation - percutaneous coronary intervention

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