Aktuelle Empfehlungen zur „Triple-Therapie” nach koronarer Stentimplantation

Zusammenfassung

Die Empfehlungen zur gerinnungshemmenden Behandlung von Patienten nach koronarer Stentimplantation sind in den Leitlinien der deutschen und internationalen Fachgesellschaften mit hohen Empfehlungs- und Evidenzgraden ausgesprochen.

Bei einer Indikation zur oralen Antikoagulation bei diesen Patienten, wie z. B. absolute Arrhythmie bei Vorhofflimmern mit moderatem oder hohem Risiko für thrombembolische Ereignisse, ist die antithrombotische Behandlung in der Diskussion. Die als „Triple-Therapie” bezeichnete Kombination von oraler Antikoagulation, Clopidogrel und Acetylsalicylsäure ist insbesondere in der frühen Phase nach einer Koronarintervention mit Stentimplantation die am häufigsten verwendete Therapieform. Diese Kombination ist mit einem erheblichen Risiko für leichte und schwerwiegende Blutungskomplikationen, insbesondere bei langfristiger Anwendung, assoziiert. In der vorliegenden Übersichtsarbeit wird an Hand der publizierten Literatur das Nutzen/Risikoprofil der Tripletherapie diskutiert.

Abstract

Antithrombotic/antiplatelet therapy after coronary stent implantation is recommended with a high level of evidence in international guidelines.

However, antithrombotic/antiplatelet treatment in patients after coronary stent implantation and in addition with an indication for oral anticoagulation is still an open issue. So called „tripletherapy”, the combination of oral anticoagulation with vitamin K-antagonists, clopidogrel and aspirin, is commonly used. This combination significantly increases incidence of minor and major bleedings, especially during long term use.

The goal of this manuscript is to discuss the risks and potential benefit of „tripletherapy” in patients with an indication for oral anticoagulation after coronary stent implantation.

perkutane Koronarintervention - Thrombozytenaggregationshemmer - orale Antikoagulation

percutaneous coronary intervention - antiplatelet therapy - oral anticoagulation

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