Thrombozytenhemmung auf der Intensivstation

Kernaussagen

• Die wesentliche und relevanteste Indikation für eine Thrombozytenhemmung auf der Intensivstation ist das akute Koronarsyndrom. Hierfür wird derzeit ASS mit Ticagrelor oder Prasugrel kombiniert. Stentthrombosen sind mit dieser Therapie selten geworden.

• Leitliniengerecht kann bei hoher Thrombuslast nach wie vor die Endstreckenblockade mit GPIIb/IIIa-Antagonisten eingesetzt werden. In diesen Fällen muss aber in besonderem Maße mit Blutungskomplikationen gerechnet werden.

• Eine zusätzliche plasmatische Antikoagulation in therapeutischer Dosierung potenziert das Blutungsrisiko zusätzlich und sollte zeitlich und auf harte Indikationen begrenzt werden.

• Mit Cangrelor wird möglicherweise bald ein i. v. applizierbarer ADP-Rezeptorantagonist zur Verfügung stehen.

• Die Therapie von Patienten mit maschinell, medikamentös oder krankheitsbedingt induzierter Thrombozytopenie ist heikel und muss fortlaufend individuell angepasst werden.

• Literatur

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