Zusammenfassung
Patienten mit Atherosklerose, besonders in der Manifestation einer symptomatischen arteriellen Verschlusskrankheit der Beine, sind Hochrisikokandidaten für ischämische Komplikationen. Sie sind in hohem Maße gefährdet, einen Myokardinfarkt oder Schlaganfall zu erleiden oder an kardiovaskulären Ereignissen zu versterben. Die Behandlung nach erfolgter Bypassoperation hat 2 Ziele. Zum einen ist im Sinne der Sekundärprävention durch Management der Risikofaktoren und Thrombozytenfunktionshemmung sowie durch Modifikation des Lebensstils dem Manifestwerden dieser Komplikationen entgegenzuwirken. Zum anderen muss die Offenheit des Bypasses möglichst lebenslang erhalten werden. Bei dieser Verschlussprophylaxe kommt der Thrombozytenantiaggregation mit ASS eine zentrale Bedeutung zu. Die orale Antikoagulation mit Vitamin-K-Antagonisten in mittlerer Dosierung hat ausschließlich beim venösen Bypass Vorteile. Bei oraler Antikoagulation ist aber immer ein im Vergleich zu ASS deutlich erhöhtes Risiko bedrohlicher Blutungen zu bedenken. Evidenzbasierte Indikationen zur Therapie mit Clopidogrel oder Dipyridamol oder zur dualen Plättchenhemmung bestehen bei pAVK nicht.
Abstract
Patients with atherosclerosis, especially when manifested as symptomatic arterial occlusive disease of the limbs, exhibit a high risk for ischemic complications. They are at high risk for myocardial infarction and stroke and are threatened by cardiovascular death. Treatment after bypass surgery has two targets: risk factors have to be managed as secondary prevention together with platelet anti-aggregation and life style modification, and therapy has to prevent bypasses from occluding, if possible lifelong. Anti-aggregation of platelets with ASS is of central importance under this aspect of graft patency. Oral anticoagulation with vitamin K antagonists with a median effective dosage is only favourable for venous grafts. In cases with oral anticoagulation, a higher risk of major hemorrhage compared to ASS has to be taken into account. There are no evidence based indications for therapy with clopidogrel, dipyridamole or dual platelet inhibition for peripheral arterial occlusive disease.
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Amendt, K. Antikoagulation oder Antiaggregation in der Bypasschirurgie bei arterieller Verschlusskrankheit der Beine (pAVK). Gefässchirurgie 12, 63–72 (2007). https://doi.org/10.1007/s00772-006-0509-5
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DOI: https://doi.org/10.1007/s00772-006-0509-5