Zusammenfassung
Hintergrund
Die Einführung von Clopidogrel war ein Meilenstein in der Entwicklung der modernen Antiplättchentherapie. Jedoch haben die Unzulänglichkeiten in der Pharmakokinetik von Clopidogrel die Suche nach alternativen Substanzen beflügelt.
Aktuelles Konzept
Prasugrel und Ticagrelor, 2 neue Substanzen, wurden in die aktuellen Leitlinien zur Behandlung von Patienten mit akutem Koronarsyndrom aufgenommen. Die potenten Plättchenhemmer gehen jedoch mit einer erhöhten Rate an Blutungen einher, was bei einem kritisch kranken Patienten von besonderer Bedeutung erscheint. Allerdings sind auch die neuen Plättchenhemmer bei schockierten oder gekühlten Patienten im Vergleich zum Gesamtkollektiv weniger wirksam.
Ausblick
Die rezenten Studien unterstreichen die Beurteilung des klinischen Nettonutzens im Patientenmanagement. Nachdem es nur eine dünne Linie zwischen Wirksamkeit und Sicherheit bei kritisch kranken Patenten gibt, erscheinen zukünftige Studien zur Risikostratifizierung der antithrombozytären Therapie im Sinne der personalisierten Medizin bei Intensivpatienten obligatorisch zu sein.
Abstract
Background
The introduction of clopidogrel was a milestone in the development of modern antiplatelet therapy. However, the shortcomings in the pharmacokinetics of clopidogrel have led to the development of alternative substances.
Current concept
The two new drugs prasugrel and ticagrelor were included in the current guidelines for the treatment of patients with acute coronary syndrome. These potent platelet inhibitors, however, are associated with an increased rate of bleeding events, which is of particular importance in critically ill patients. However, the new platelet inhibitors are less effective in patients with cardiogenic shock or patients treated with therapeutic hypothermia.
Future
Recent studies underscore the assessment of the net clinical benefit in patient management. Since there is only a thin line between efficacy and safety in critically ill patients, future studies for risk stratification of antiplatelet therapy in terms of personalized medicine are mandatory.
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Einhaltung ethischer Richtlinien
Interessenkonflikt. G. Delle-Karth erhielt Vortrags- oder Beraterhonorare von AstraZeneca und Daiichi Sankyo. J.M. Siller-Matula erhielt Vortrags- oder Beraterhonorare vom AstraZeneca, Eli Lilly und Daiichi Sankyo.
Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Siller-Matula, J., Delle Karth, G. Duale Plättchenhemmung in der Intensivmedizin. Med Klin Intensivmed Notfmed 109, 429–436 (2014). https://doi.org/10.1007/s00063-014-0394-8
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DOI: https://doi.org/10.1007/s00063-014-0394-8