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Kardiologie up2date 2024; 20(01): 65-76
DOI: 10.1055/a-2129-5915
Thrombozyten und Gerinnungssystem

Antithrombotische Therapiestrategien in der Atherosklerose

Martin Moser
,
Dirk Westermann
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Atherosklerose und ihre Folgen stellen eine wichtige Krankheits- und Todesursache weltweit dar. Je nach Stadium und Risikoprofil der Erkrankung sind daher differenzierte antithrombotische Strategien erforderlich. Ob es sich um Primärprävention oder chronische Atherosklerose handelt – für jeden Patienten muss eine Therapiestrategie gefunden werden, für die eine individuelle Nutzen-Risiko-Abwägung unerlässlich ist.
Kernaussagen

  • Zur Prävention und Therapie der Atherosklerose gehört eine differenzierte antithrombotische Herangehensweise.

  • Im chronischen Stadium ist eine plättchenfunktionshemmende Monotherapie ausreichend.

  • Nach akuten Ischämien oder Gefäßinterventionen wird eine doppelte Plättchenaggregationshemmung (DAPT) notwendig, deren Dauer von den Begleitumständen abhängt.

  • Die Verlängerung oder Intensivierung der DAPT führt zwar zu einer Verschiebung des Verhältnisses von ischämischen gegenüber Blutungsendpunkten, die Sterblichkeit bleibt aber unverändert.

  • Die differenzierte Kombinationstherapie aus Plättchenfunktionshemmung und Hemmung der Gerinnungskaskade (DAT) ist in unterschiedlichen Dosierungen entsprechend den jeweiligen klinischen Konstellationen möglich.

  • Die niedrigdosierte DAT kommt für Patienten in arteriellen Hochrisikosituationen infrage.

  • Die Volldosis-DAT ist dagegen Therapie der Wahl für die ersten 6–12 Monate bei Patienten mit Indikation zur therapeutischen Gerinnungshemmung und zusätzlichen arteriellen Ereignissen wie PCI – ASS ist dann nur noch unmittelbar periinterventionell erforderlich.

Schlüsselwörter

Atherosklerose - antithrombotische Therapie - Plättchenfunktionshemmung - Antikoagulation


Publication History

Article published online:
18 March 2024

© 2024. Thieme. All rights reserved.

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