Clinical Research in Cardiology

, Volume 95, Supplement 1, pp i74–i77 | Cite as

Postoperative antithrombotische Therapie bei diabetischen Patienten

  • M. Klutmann
  • C. Tillmanns
  • D. C. Gulba
Article

Zusammenfassung

Diabetiker nach koronarer Bypassoperation stellen eine besondere koronare Risikokohorte dar. Die Sekundärprävention besteht auch bei diesen Patienten auf plättchen- und gerinnungshemmenden Prinzipien. Die Frage der Sekundärprävention diabetischer Koronarpatienten wurde bisher nicht in spezifischen Studien adressiert, sodass die Behandlung ganz von der Risikostratefizierung dieser Patienten geleitet wird. Diabetische Infarktpatienten haben das höchste Risiko, weshalb hier auch unter Berücksichtigung der begrenzten Ressourcen der Einsatz von Acetylsalicylsäure in Kombination mit Clopidogrel gerechtfertigt erscheint. Eine wirksame Alternative stellt die systemische Antikoagulation mit Kumarinen dar. Sie sollte bei Vorliegen zusätzlicher anatomischer Voraussetzungen (Ventrikelaneurysmen, EF <30%, bestimmte koronaranatomische Bedingungen) als Alternative zur Plättchenhemmung liberaler als bisher indiziert werden.

Schlüsselwörter

Diabetes mellitus antithrombotische Therapie Herzchirurgie Gerinnungshemmung Plättchenhemmung 

Postoperative antithrombotic treatment in diabetic patients

Summary

Diabetes mellitus patients after aorto-coronary bypass operation constitute a patient cohort at largely increased risk for secondary coronary events. Antiplatelet agents and antithrombotic agents are applied for secondary prevention. Up to now, secondary prevention has not been addressed specifically in the cohort of diabetic patients after bypass operation. Hence therapeutic recommendations are derived from the global cohort of CAD patients and based on risk assessment rather than on specific data. Since diabetic patients after myocardial infarction are at particularly high risk, combined therapy with clopidogrel and ASS may be considered even with restricted resources in the health system. Oral anticoagulation with coumadin constitutes an effective alternative to dual anti-platelet therapy. Under specific conditions (ventricular aneurysms, EF <30%, or certain conditions in coronary anatomy) oral anticoagulants should be considered more liberally than currently.

Key words

Diabetes mellitus antithrombotic therapy heart surgery coagulation inhibition platelet inhibition 

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Copyright information

© Steinkopff-Verlag 2006

Authors and Affiliations

  • M. Klutmann
    • 1
  • C. Tillmanns
    • 1
  • D. C. Gulba
    • 1
  1. 1.Medizinische Klinik I Schwerpunkte: Kardiologie, Angiologie & PulmonologieKrankenhaus Düren gGmbHDüren

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