Thrombolysetherapie beim akuten Herzinfarkt

Zusammenfassung

Thrombolytische Therapie von Patienten mit frischem Herzinfarkt führt in über der Hälfte der Fälle zu einer frühen Rekanalisation des thrombotisch verschlossenen Infarktgefäßes. Intravenös verabreichter Gewebeplasminogenaktivator ist vergleichbar wirksam wie intrakoronar infundierte Streptokinase oder Urokinase. Prourokinase und acylierte Streptokinase sind neue Thrombolytika, deren Wirksamkeit bisher noch nicht ausreichend zu beurteilen ist. Risikopatienten, d. h. Patienten in höherem Alter, mit primär erniedrigter linksventrikulärer Herzfunktion und mit Zweitinfarkt scheinen besonders von der thrombolytischen Therapie zu profitieren. Entscheidend für die Prognose des Patienten ist ein möglichst frühzeitiges Einsetzen der Therapie, um reversibel geschädigtes Myokard zu retten.

Ungelöste Probleme sind die relativ hohen Raten früher Reokklusion nach i.e. SK und nach i.v. t-PA sowie die unklare Bedeutung der systemischen Aktivierung des fibrinolytischen Systems.

Die intravenöse Infusion eines Thrombolytikums ist in jedem Krankenhaus möglich. Die Entscheidung über eine invasive Weiterbehandlung mittels transluminaler koronarer Angioplastie bzw. eines aortokoronaren Bypass sollte danach unverzüglich in einem spezialisierten Zentrum herbeigeführt werden.

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