Plättchenfunktionshemmer neue pharmakologische Ansätze

Zusammenfassung

Ziel der klinischen Therapie mit Thrombozytenfunktionshemmern ist eine Verhinderung von thrombotischen Gefäßverschlüssen bei bestehendem erhöhten vaskulären Risiko. Aufgrund der Physiologie der Plättchenaktivierung eignen sich hierfür besonders solche Pharmaka, die mit rezeptorgekoppelten zellulären Transduktionsmechanismen interferieren. Azetylsalizylsäure (ASS) als Referenzsubstanz hat den Vorteil einer irreversiblen Hemmung der Plättchensekretion und guter Verträglichkeit bei niedriger Dosierung (<100 mg/d), die offenbar für die Prävention des Herzinfarkts ausreicht. Thromboxansynthesehemmer wirken im Gegensatz zu ASS nicht negativ auf die vaskuläre Prostazyklinsynthese, waren aber in der Klinik bisher ASS nicht überlegen. Thromboxanrezeptorenblocker führen zu einer kombinierten Hemmung von Plättchensekretion und thromboxanmediierten Gefäßspasmen. Neuere oral wirksame Substanzen (GR 32.191; Bay U 3405) scheinen einen Langzeiteffekt zu besitzen. Von erheblichem Interesse sind monoklonale Antikörper gegen den GP-llb/llla-Komplex sowie Hirudin und Ticlopidin.

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