Gefässchirurgie

, Volume 18, Issue 3, pp 231–240 | Cite as

Akute koronare Syndrome

Präklinische antithrombotische Therapie
CME Zertifizierte Fortbildung
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Zusammenfassung

Die antithrombotische Therapie ist einer der wichtigsten Bausteine in der Akut- und Langzeitbehandlung der Patienten mit akuten koronaren Syndromen (AKS). Hierbei werden sowohl Thrombozytenfunktionshemmer als auch Antikoagulanzien eingesetzt. Diese können einerseits durch die Reduktion von Ischämien die Prognose verbessern, andererseits durch die Zunahme von Blutungskomplikationen zu einer höheren Sterblichkeit führen. Daher sind insbesondere in der präklinischen Phase einfache und sichere antithrombotische Therapieregimes sinnvoll, um nicht durch Über- und Unterdosierungen zu Komplikationen beizutragen. Bei den Thrombozytenhemmern ist die Azetylsalizylsäure die am besten untersuchte Substanz, die jeder Patient mit AKS erhalten sollte. Zusätzlich ist in der Regel ein ADP-Rezeptor-Blocker (ADP: Adenosindiphosphat) sowohl in der Akuttherapie als auch in der Sekundärprävention über die Dauer von 12 Monaten sinnvoll. Dagegen ist der Nutzen der Antikoagulation im Wesentlichen für die Akutphase des AKS belegt. Es werden die derzeitige Daten- und Empfehlungslage zur präklinischen antithrombotischen Therapie bei AKS zusammengefasst.

Schlüsselwörter

Akute koronare Syndrome Präklinische Phase Thrombinhemmer Thrombozytenhemmer Antikoagulanzien 

Abkürzungsverzeichnis

ADP

Adenosindiphosphat

AKS

Akutes Koronarsyndrom

aPTT

Aktivierte partielle Thromboplastinzeit

ASS

Azetylsalizylsäure

ATLANTIC

„Pre-hospital vs. in-hospital initiation of ticagrelor therapy in STEMI patients planned for percutaneous coronary intervention (PCI)“

ATOLL

„STEMI treated with primary angioplasty and intravenous lovenox or unfractionated heparin (UFH)“

CIPAMI

„Clopidogrel administered prehospital to improve primary PCI in patients with acute myocardial infarction“

CLARITY-TIMI 28

„Clopidogrel as adjunctive reperfusion therapy – thrombolysis in myocardial infarction – 28“

COMMIT-Studie

„Chinese metroprolol trial“

COX

Cyclooxygenase

CURE

„Clopidogrel in unstable angina to prevent recurrent events“

EARLY-ACS

„Early glycoprotein IIb/IIIa inhibition in patients with non-ST-segment elevation acute coronary syndrome“

ETAMI

„Early thienopyridine treatment to improve primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction“

EuroMAX

„European ambulance acute coronary syndrome (ACS) Angiox trial“

FINESSE

„A study of abciximab and reteplase when administered prior to catherization after a myocardial infarction“

HORIZONS

„Harmonizing outcomes with revascularization and stents in acute myocardial infarction“

IE

Internationale Einheiten

INR

„International normalized ratio“

ISIS-2

„Second international study of infarct survival“

i.v.

Intravenös

KG

Körpergewicht

NSTE

Nicht-ST-Streckenhebung

OnTIME-2

„Prehospital initiation of tirofiban in patients with ST-elevation myocardial infarction undergoing primary angioplasty“

PCI

„Percutaneous coronary intervention“

PLATO

„Platelet inhibition and patient outcomes“

RRR

Relative Risikoreduktion

s.c.

Subkutan

STEMI

ST-Streckenhebungsmyokardinfarkt

TRITON

„Trial to assess improvement in therapeutic outcomes by optimizing platelet inhibition“

TXA2

Thromboxan A2

Acute coronary syndromes

Prehospital antithrombotic therapy

Abstract

Antithrombotic treatment is one of the cornerstones of acute and long-term therapy of patients with acute coronary syndromes (ACS). For this purpose antiplatelet as well as antithrombin agents are used. These drugs can reduce mortality and recurrent ischemic events but may increase bleeding complications. Therefore, simple and easy to use antithrombotic regimens are desirable especially in the prehospital phase to reduce complications associated with overdosing and underdosing. Aspirin is well established for all patients with ACS. In addition an adenosine diphosphate (ADP) receptor blocker should be given in acute therapy and over 12 months after ACS. The value of thrombin inhibitors has been documented mainly for the acute phase. This article summarizes currently available data and recommendations for prehospital antithrombotic therapy in patients with ACS.

Keywords

Acute coronary syndrome Prehospital phase Platelet inhibitors Antithrombins Anticoagulants 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Klinikum LudwigshafenLudwigshafen Deutschland
  2. 2.Institut für Herzinfarktforschung LudwigshafenLudwigshafenDeutschland

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