Notfall + Rettungsmedizin

, Volume 10, Issue 7, pp 500–510 | Cite as

Frühe Antiplättchentherapie und Gerinnungshemmung bei akutem Koronarsyndrom

Hintergrund und aktuelle Studienlage
Leitthema

Zusammenfassung

Die antithrombozytäre und antikoagulatorische Therapie bei akutem Koronarsyndrom (AKS) entwickelt sich mit kaum noch zu überblickender Dynamik als Folge der Verfügbarkeit neuer Substanzen, neuer Kombinationen und neuer Therapiestrategien. Die vielfältigen möglichen Kombinationen gerinnungshemmender Pharmaka sind noch lange nicht alle erprobt und bieten Chancen zu weiterem Fortschritt. Demgegenüber steht das Problem eines steigenden Blutungsrisikos, das in vielen Fällen den Nutzen hinsichtlich der Vermeidung insbesondere früher koronarer Rezidivereignisse zumindest teilweise aufzuheben droht. Besonders stark erhöhte Blutungsrisiken fanden sich z. B. beim Einsatz von Glykoprotein-IIb/IIIa-Rezeptorblockern in Kombination mit Thrombolytika (v. a. Streptokinase) oder hochdosiertem Enoxaparin bei älteren weiblichen Patienten mit geringem Körpergewicht. Im Gegensatz dazu steigert Clopidogrel in der Akuttherapie die Blutungsrisiken wenn überhaupt nur unwesentlich und ist auch langfristig eine Schlüsseltherapie bei AKS. Vorsichtige Therapieansätze mit reduzierten, risikoangepassten Dosierungen bei Patienten über 75 Jahren und solchen mit deutlich eingeschränkter Nierenfunktion, die beispielhaft in der EXTRACT-TIMI-25-Studie für Enoxaparin gezeigt werden, sind geeignet, den langen Weg bis zu einer optimalen gerinnungshemmenden Behandlung bei akutem Koronarsyndrom zu sichern.

Schlüsselwörter

Akutes Koronarsyndrom Antithrombozytäre Therapie Antikoagulation Glykoprotein-IIb/IIIa-Rezeptorenblocker Thrombolytika 

Early antiplatelet therapy and anticoagulation for acute coronary syndrome: Background and recent studies

Abstract

Antiplatelet and antithrombin treatment for patients suffering from acute coronary syndrome is dynamically developing with increasing speed due to new agents, new combinations and new therapeutic strategies. Many combinations of anticoagulants and antiplatelets have not yet been tested and may offer new chances for therapeutic success. These chances are opposed by an increasing bleeding risk which may at least partially abolish the advantages achieved with more aggressive treatment targeting to avoid early adverse coronary events. Bleeding is profoundly elevated with the combination of Glycoprotein IIb/IIIa receptor blockers and thrombolytics, notably streptokinase. Also high dose enoxaparin leads to more major hemorrhages when given to elderly female patients with low body weight. In contrast, clopidogrel does not increase bleeding risk or if at all only to a minimal extent, thus becoming a key medication for patients presenting with signs of an acute coronary syndrome. Cautious treatment strategies with risk-adjusted dosing e.g. in elderly patients over 75 years of age and patients with renal impairment as exemplary executed in the ExTRACT-TIMI 25 study show the way to optimal and safe anticoagulation therapy for patients with an acute coronary syndrome.

Keywords

Acute coronary syndrome Antitplatelet therapy Anticoagulation Glycoprotein IIb/IIIa receptor inhibitors Thrombolytics 

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Copyright information

© Springer Medizin Verlag 2007

Authors and Affiliations

  1. 1.Medizinische Klinik II, Kardiologie und PulmologieCharité, Campus Benjamin FranklinBerlinDeutschland

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