Antithrombotische Therapie bei polyvaskulärer Atherosklerose

Patienten mit polyvaskulärer Atherosklerose haben ein doppelt so hohes Risiko für kardiovaskuläre Ereignisse wie Patienten mit monovaskulärer Atherosklerose. Eine gerinnungshemmende Therapie verbessert die Prognose und ist effektiver in der Risikoreduktion, aber mit einem höheren Blutungsrisiko assoziiert. Im Vergleich zu Patienten mit monovaskulärer Atherosklerose profitieren dabei Patienten mit polyvaskulärer Atherosklerose mehr, da das absolute Risiko für ischämische Ereignisse höher ist, bei vergleichbar gleichem Blutungsrisiko.

Abstract

Patients with polyvascular atherosclerosis are twice as likely to have cardiovascular events as patients with monovascular atherosclerosis. Anticoagulant therapy improves the prognosis and is therefore clearly recommended. Intensified anticoagulation is more effective in reducing risk but is associated with a higher risk of bleeding. Compared to patients with monovascular atherosclerosis, patients with polyvascular atherosclerosis benefit more, as the absolute risk of ischemic events is higher – with the same risk of bleeding.

Kernaussagen

• Patienten mit polyvaskulärer Atherosklerose haben ein hohes Risiko für MACE- und MALE-Ereignisse. Eine gerinnungshemmende Therapie senkt das Risiko für kardiovaskuläre Ereignisse und ist daher bei polyvaskulärer Atherosklerose indiziert.

• Eine intensivierte Gerinnungshemmung bringt in Bezug auf die Reduktion von MACE- und MALE-Ereignisse Vorteile, ist aber auch mit einem erhöhten Blutungsrisiko assoziiert.

• Aktuelle Leitlinien empfehlen bei hohem Risiko für schwerwiegende Ereignisse und niedrigem Blutungsrisiko die Gabe von ASS 100mg und niedrig dosiertem Rivaroxaban (2× 2,5mg). Ist das Blutungsrisiko erhöht, wird die Gabe eines einzigen Thrombozyten-Aggregationshemmers (ASS oder ADP-Rezeptor-Antagonisten) empfohlen.

Schlüsselwörter

Atherosklerose - polyvaskulär - Gerinnungshemmung - Prognose

Keywords

atherosclerosis - polyvascular - antithrombotic therapy - prognosis

Publication History

Article published online:
28 May 2025

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