Interdisziplinäres Management von Blutungen unter dualer antithrombozytärer Therapie nach akutem Koronarsyndrom

Zusammenfassung

Zur Sekundärprophylaxe eines akuten Koronarsyndroms (ACS) wird die duale antithrombozytäre Therapie (DAPT) mit Acetylsalicylsäure und einem P2Y₁₂-Adenosindiphosphat-Rezeptorblocker wie Clopidogrel, Prasugrel und Ticagrelor für eine Dauer von 12 Monaten in den Leitlinien empfohlen. Ein frühzeitiges Absetzen der DAPT ist mit einem erhöhten Risiko für ischämische Ereignisse verbunden. Die antithrombozytäre Therapie ist allerdings auch mit einem erhöhten Risiko für Blutungen assoziiert, welches nicht unter- aber auch nicht überschätzt werden sollte. Um eine optimale Versorgung der Patienten unter DAPT nach einem ACS zu gewährleisten, hat eine interdisziplinäre Gruppe erfahrener Experten aus den Bereichen Kardiologie, Kardiochirurgie, Gastroenterologie, Anästhesiologie, Intensivmedizin und Hämostaseologie praxisrelevante Informationen und Empfehlungen erarbeitet. Diese schließen die Bedeutung von Blutungen im Verlauf der Therapie, Maßnahmen zur Prävention und die optimale Versorgung von Patienten mit Blutungen ein.

Abstract

For secondary prevention of acute coronary syndrome, guidelines recommend dual antiplatelet therapy with acetylsalicylic acid and a P2Y₁₂ receptor antagonist such as clopidogrel, prasugrel or ticagrelor for a period of 12 months. Premature discontinuation of dual antiplatelet therapy is associated with an increased risk of ischaemic events. However, antiplatelet therapy is also associated with an increased risk of bleeding that should not be under- or overestimated. To ensure an optimal care of patients receiving dual antiplatelet therapy after an acute coronary syndrome, an interdisciplinary group of experienced experts in the fields of cardiology, cardiac surgery, gastroenterology, anaesthesiology, intensive care and haemostaseology gathered bleeding-related information and developed recommendations relevant to daily clinical practice. These include the significance of bleeding events in the course of treatment, measures for bleeding prevention and the adequate care of patients with bleedings.

Schlüsselwörter

ADP-Rezeptorblocker - Akutes Koronarsyndrom (ACS) - Blutung - Duale Plättchenhemmung (DAPT) - Thrombozytenaggregationshemmung

Keywords

Acute coronary syndrome - Dual antiplatelet therapy - Hemorrhage - Platelet aggregation inhibitors - Purinergic P2Y receptor antagonist

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