Hämostaseologische Aspekte der Atherothrombose bei Diabetes

Einleitung

Menschen mit Diabetes mellitus leiden und sterben nach wie vor besonders häufig an den ­mikro- und makrovaskulären Komplikationen ihrer Erkrankung. Besonders hoch ist dabei die Mortalität des akuten Koronarsyndroms und des zerebrovaskulären Insults [1] [2] . Über 60 % der Todes­fälle unter männlichen insulintherapierten Typ-2-Diabetikern und über 50 % bei Diabetikerinnen im Alter zwischen 40 und 59 Jahren sind Folge ischämischer Schlaganfälle [3]. In der UKPDS-Studie wiesen bei Rekrutierungsstart bereits fast 50 % der Patienten mit Diabetes mellitus mikro- oder makrovaskuläre Komplikationen auf [4]. Dabei liegt dem typischen makro­vaskulären Ereignis die Ruptur atherosklerotischer arterieller Plaques zugrunde, welche die ­Adhäsion und Aggregation von Thrombozyten auslöst, die schließlich einen arteriellen Gefäßverschluss mit konsekutiver Ischämie der Gefäßstrombahn bewirken [5]. Auch venöse Thromboembolien sind bei Diabetikern häufiger als bei Stoffwechselgesunden [6]. 

Die gesicherte Stellung des Diabetes mellitus als unabhängiger Risikofaktor thromboembolischer Ereignisse

Diabetes mellitus ist ein gesicherter unabhängiger Risikofaktor für thromboembolische Ereignisse.

 ist multifaktoriell bedingt. Tatsächlich finden sich bei diabetischer Stoffwechsellage komplexe prokoagulatorische Veränderungen des Gerinnungssystems im Bereich aller beteiligten Systeme. 

Die Wahl geeigneter präventiver und therapeutischer Maßnahmen sollte auf der Kenntnis der typischen Veränderungen basieren. Der vorliegende CME-Artikel soll deshalb dazu dienen, die wesentlichen diabetesassoziierten Störungen der Hämostase kurz zu rekapitulieren. Einige Therapiebesonderheiten sind für Diabetiker mit makrovaskulären Komplikationen in der Praxis zu beachten und haben teilweise Eingang in entsprechende Leitlinien gefunden. 

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