Diabetes und kardiovaskuläre Ereignisse

ZUSAMMENFASSUNG

Bei Diabetes kommt es in Abhängigkeit von Dauer und Einstellung zu zahlreichen hämostaseologischen Veränderungen, die in einen prothrombotischen Status resultieren und zur hohen kardiovaskulären Ereignisrate beitragen. Zur Reduktion der Ereignisrate wird eine prophylaktische Gabe von Acetylsalicylsäure (ASS) diskutiert. Entscheidend ist dabei ein positiver Nettoeffekt, dies bedeutet, dass mehr kardiovaskuläre Ereignisse verhindert als Blutungen verursacht werden. Nach einem kardialen Ereignis ist das ischämische Risiko deutlich höher, sodass die Kombination aus 2 Thrombozyteninhibitoren (DAPT) für eine begrenzte Dauer verschrieben wird. Bei besonders hohem Risiko und niedrigem Blutungsrisiko kann die DAPT fortgesetzt oder eine Dual-Pathway Therapie mit ASS und niedrig dosiertem Rivaroxaban eingesetzt werden. Bei gleichzeitigem Vorliegen von Vorhofflimmern steht die Fortsetzung der oralen Antikoagulation mit einem NOAK (Neue orale Antikoagulanzien) im Vordergrund und die Thrombozyteninhibitortherapie wird in deutlich reduzierter Dauer und Intensität empfohlen.

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