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Hamostaseologie 2006; 26(02): 138-146
DOI: 10.1055/s-0037-1616884
Original article
Schattauer GmbH

Akutes Koronarsyndrom

Peri-interventionelle antithrombotische TherapieAcute coronary syndromeperi-interventional antithrombotic therapy
T. Wichter
1   Medizinische Klinik und Poliklinik, Kardiologie und Angiologie (Direktor: Univ.-Prof. Dr. med. G. Breithardt), Universitätsklinikum Münster
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Publication History

Publication Date:
27 December 2017 (online)

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Zusammenfassung

Bei Patienten mit akutem Koronarsyndrom erlangte die peri-interventionelle antithrombotische Therapie in den vergangenen Jahren zunehmend Bedeutung für die Wahl der bevorzugten Reperfusionsstrategie und der adjuvanten medikamentösen Behandlung vor, während und nach perkutanen Koronarinterventionen (PCI).

Bei NSTE-ACS und früh-invasiver Therapiestrategie (<48 h) sollte möglichst frühzeitig eine Behandlung mit Azetylsalizylsäure (ASS), Clopidogrel und Heparin (UFH bevorzugt) eingeleitet werden. Direkte Thrombininhibitoren stellen insbesondere bei erhöhter Blutungsneigung oder heparininduzierter Thrombozytopenie eine Alternative zu unfraktioniertes Heparin (UFH) dar.

Bei Patienten mit hohem Risiko sollte ,,upstream“ ein Glykoprotein-IIb/IIIa- Inhibitor (Eptifibatid, Tirofiban) eingesetzt werden. Bei STEMI stellt die primäre PCI die Reperfusionstherapie der Wahl dar und sollte durch frühzeitige Gabe von ASS, Clopidogrel, UFH und Glykoprotein-IIb/IIIa-Inhibitoren (Abciximab, Eptifibatid) unterstützt werden. UFH wird dabei gegenüber niedermolekularem Heparin wegen geringerer Blutungsraten und besserer Möglichkeit zur Antagonisierung favorisiert. Eine so genannte facilitated PCI mit Thrombolytika wird wegen höherer Mortalität und Komplikationsraten nicht empfohlen.

Summary

In patients with acute coronary syndrome (ACS), the periinterventional antithrombotic treatment has become increasingly important for the choice of reperfusion strategy and as an adjunct pharmacological treatment prior, during and after percutaneous coronary interventions (PCI).

In NSTE-ACS and early invasive strategy (<48 h), treatment with ASA, clopidogrel and heparin – unfractionated heparin (UFH) preferred – should be initiated as soon as possible. Direct thrombin inhibitors are an alternative to heparin, particularly in the setting of increased risk of bleeding and heparin-induced thrombocytopenia. In highrisk patients, an so-called upstream therapy with glycoprotein IIb/IIIa inhibitors (tirofiban, eptifibatide) is recommended as an adjunct to PCI.

In STEMI, primary PCI is the reperfusion therapy of choice and should be supported by early adjunct treatment with ASA, clopidogrel, UFH and glycoprotein IIb/IIIa inhibitors (abciximab, eptifibatide). ,,Facilitated“ PCI with thrombolytics is not recommended because of increased mortality and complication rates. Acute coronary syndrome: peri-interventional antithrombotic therapy

Schlüsselwörter

Akutes Koronarsyndrom - Myokardinfarkt - Antikoagulation - antithrombotische Therapie

Keywords

Acute coronary syndrome - myocardial infarction - anticoagulation - antithrombotic therapy
 

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