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Plättchenhemmung und Antikoagulation beim akuten Koronarsyndrom

Aktuelle Evidenz

Antiplatelet therapy and anticoagulation in acute coronary syndrome

Current evidence

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Zusammenfassung

In den letzten Jahren konnte die Prognose beim akuten Koronarsyndrom (ACS) signifikant verbessert werden. Dies ist vor allem auf den breiten Einsatz der perkutanen Koronarintervention (PCI) zurückzuführen. Neben der mechanischen Reperfusion ist eine optimale medikamentöse Strategie von immanenter Bedeutung. Hierbei kommt der antithrombozytären sowie der periinterventionellen antithrombotischen Therapie eine wichtige Rolle zu. Zur Aggregationshemmung stehen neben Acetylsalicylsäure und Clopidogrel auch neue potentere P2Y12-Inhibitoren wie Prasugrel und Ticagrelor zur Verfügung. Auch zur Antikoagulation vor, während sowie nach der PCI wurden neben unfraktioniertem Heparin auch weitere Medikamente, wie das niedermolekulare Heparin Enoxaparin, das synthetische Pentasaccharid Fondaparinux sowie der direkte Thrombinantagonist Bivalirudin eingeführt, welche mit oder ohne zusätzliche Gabe von Glykoprotein-IIb/IIIa-Inhibitoren verabreicht werden können. Im Folgenden wird eine Übersicht zur plättchenhemmenden Medikation und periprozeduralen Antikoagulation bei Patienten mit ACS gegeben sowie die aktuelle Evidenz diskutiert.

Abstract

In recent years, the prognosis of patients with an acute coronary syndrome (ACS) has significantly improved. This can mainly be attributed to the implementation of primary percutaneous coronary intervention (PCI). Apart from mechanical reperfusion, an optimal medical strategy is of great importance. Antiplatelet and antithrombotic therapies in particular play a crucial role in the management of patients with ACS. New options in antiplatelet therapy are more potent P2Y12 inhibitors in addition to acetylsalicylic acid and clopidogrel. Furthermore, anticoagulant therapy before, during and after PCI can be performed by the use of unfractionated heparin, low molecular weight heparins, such as enoxaparin, the synthetic pentasaccharide fondaparinux and the direct thrombin inhibitor bivalirudin with or without additional administration of glycoprotein IIb/IIIa inhibitors. In this article, data on antiplatelet and anticoagulant therapy are presented and the current evidence is discussed.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. S. de Waha, H. Thiele und G. Richardt geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Department of Cardiology and Angiology, Heart Center Bad Segeberg, Am Kurpark 1, 23795, Bad Segeberg, Deutschland

    S. de Waha & G. Richardt

  2. Medizinische Klinik II, Universität Lübeck, Lübeck, Deutschland

    H. Thiele

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  1. S. de Waha
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Correspondence to S. de Waha.

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de Waha, S., Thiele, H. & Richardt, G. Plättchenhemmung und Antikoagulation beim akuten Koronarsyndrom. Herz 39, 692–701 (2014). https://doi.org/10.1007/s00059-014-4132-z

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