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Der Anaesthesist

, Volume 56, Issue 4, pp 401–412 | Cite as

Koronare Stents, duale Antiplättchentherapie und die perioperative Problematik

  • H. Metzler
  • K. Huber
  • S. Kozek-Langenecker
  • M.N. Vicenzi
  • A. Münch
CME Weiterbildung • Zertifizierte Fortbildung

Zusammenfassung

Bei perkutaner koronarer Intervention werden in bis zu 90% der Fälle Koronarstents implantiert. Sie erfordern typabhängig eine duale Antiplättchentherapie (Clopidogrel und Acetylsalicylsäure). Die Therapiedauer liegt bei 3–4 Wochen bzw. 6–12 Monaten bei Bare-Metal- bzw. Drug-Eluting-Stents. Absetzen der dualen Antiplättchentherapie erhöht das Risiko einer Stentthrombose, ihre Weiterführung das einer relevanten Blutung im Operationsgebiet. Das perioperative Vorgehen stützt sich auf Empfehlungen anästhesiologischer und kardiologischer Gesellschaften. Bei Eingriffen mit hohem Blutungsrisiko kann von chirurgischer Seite ein Absetzen beider Substanzen erforderlich sein, bei hohem Thromboserisiko sollten beide Medikamente, zumindest aber Acetylsalicylsäure, bis zum Operationstag gegeben werden. Für die Durchführung einer Regionalanästhesie existieren Empfehlungen von nationalen Gesellschaften. Patienten, die nach koronarer Stentimplantation unter dualer Antiplättchentherapie stehen, profitieren von einer interdisziplinären Betreuung durch Anästhesiologen, Operateur und Kardiologen.

Schlüsselwörter

Perkutane koronare Intervention Koronare Stentimplantation Duale Antiplättchentherapie Perioperative Stentthrombose Regionalanästhesie 

Coronary stents, dual antiplatelet therapy and peri-operative problems

Abstract

Up to 90% of all percutaneous coronary interventions include coronary artery stenting. Dual antiplatelet therapy, usually involving acetylsalicyl acid combined with clopidogrel, is mandatory for patients with coronary artery stents. The duration of antiplatelet therapy for bare metal stents is 3–4 weeks, for drug eluting stents 6–12 months. Preoperative discontinuation of both drugs increases the risk of stent thrombosis, continuation the risk of relevant bleeding. According to the recommendations of anaesthesiological and cardiological societies, perioperative management has to balance the risk of bleeding vs stent thrombosis. Surgery involving a high risk of bleeding can require the discontinuance of both substances. In cases of high thrombosis risk, at least the acetylsalicyl acid should be continued until the day of surgery. For patients under antiplatelet therapy scheduled for local anaesthesia, national recommendations exist. A close collaboration between the anaesthesiologist, cardiologist and surgeon is essential for appropriate pre-, intra- and postoperative management.

Keywords

Percutaneous coronary intervention Coronary stent implantation Dual antiplatelet drug therapy Perioperative stent thrombosis Regional anaesthesia 

Notes

Interessenkonflikt

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

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Copyright information

© Springer Medizin Verlag 2007

Authors and Affiliations

  • H. Metzler
    • 1
  • K. Huber
    • 2
  • S. Kozek-Langenecker
    • 3
  • M.N. Vicenzi
    • 1
  • A. Münch
    • 1
  1. 1.Universitätsklinik für Anästhesiologie und IntensivmedizinMedizinische Universität GrazGrazÖsterreich
  2. 2.3. Medizinische Abteilung mit Kardiologie und internistischer NotaufnahmeWilhelminenspitalWienÖsterreich
  3. 3.Universitätsklinik für Allgemeine Anästhesie und Intensivmedizin BMedizinische Universität WienWienÖsterreich

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