Nachbehandlung der pAVK nach Interventionen und Gefäßchirurgie mit Antikoagulanzien und Thrombozytenfunktionshemmern

Zusammenfassung

Sowohl nach Gefäßoperationen als auch katheterinterventionellen Eingriffen bei pAVK erfolgt in der Regel eine medikamentöse Nachbehandlung mit Thrombozytenfunktionshemmern bzw. Antikoagulanzien. Nur in Teilbereichen sind diese Therapien in Hinblick auf Effektivität (Offenheitsrate, Mortalität) und Sicherheit (Blutungskomplikationen) entsprechend evaluiert.

Eine ausreichend sichere Datenbasis gibt es nur für die Nachbehandlung von Prothesenbypässen mit Azetylsalizylsäure, in den übrigen Indikationen ist weder der Einsatz von Thrombozytenfunktionshemmern noch von Antikoagulanzien sicher belegt.

Die Empfehlung, Azetylsalizylsäure bei allen infrainguinalen Bypässen wie auch nach endovaskulären Katheterinterventionen dauerhaft einzusetzen, erfolgt vor allem auch unter dem Gesichtspunkt der Sekundärprophylaxe bei manifester arterieller Gefäßerkrankung.

Summary

Platelet inhibitors and anticoagulants are used in the longterm treatment after successful infrainguinal bypass grafts as well as endovascular revascularisation procedures. However, evidence of the usefulness of these therapies is limited with respect to efficiency (patency rate, mortality) and safety (bleeding tendency) concerning these indications. Sufficient data are only available for acetylsalicylic acid treatment after implantation of prosthetic bypass grafts, the data basis for the use of antithrombotic medication in venous bypass grafts or following successful balloon angioplasty with or without stent implantation is, however, inconclusive.

The recommendation for lifelong therapy with acetylsalicylic acid after infrainguinal bypass surgery and endovascular treatment is based mainly on the concept of prophylactic treatment of manifest atherosclerotic disease.

Schlüsselwörter

Thrombozytenfunktionshemmer - Antikoagulanzien - periphere arterielle Verschlusserkrankung - Gefäßchirurgie - Dilatation

Keywords

Platelet inhibitors - anticoagulants - peripheral arterial disease - vascular surgery - dilatation

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