Antithrombotische Therapie bei Patienten mit Indikation zur oralen Antikoagulation und koronarer Stentimplantation

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Zusammenfassung

Die perkutane koronare Intervention (PCI) mit Stentimplantation erfordert eine duale Thrombozytenhemmung mit Acetylsalizylsäure (ASS) und einem Thienopyridin. Erst durch diese Kombinationstherapie konnte die Rate von Stentthrombosen reduziert werden, was eine breite Anwendung von koronaren Stents ermöglichte. Stents werden heute bei etwa 90% aller PCIs eingesetzt. Während die duale Plättchenhemmung nach Bare-metal-Stents nur für 4 Wochen zwingend erforderlich ist, sollte sie bei Patienten mit Drug-eluting-Stents über 6–12 Monate durchgeführt werden. Probleme ergeben sich bei Patienten mit der Notwendigkeit einer oralen Antikoagulation. Die Kombination von oraler Antikoagulation und dualer Plättchenhemmung ist mit einem erhöhten Risiko für Blutungskomplikationen verbunden. Randomisierte Studien zur optimalen antithrombotischen Therapie bei diesen Patienten liegen noch nicht vor, so dass die Entscheidung über die Intensität und Dauer der Kombination von oraler Antikoagulation und Thrombozytenhemmung individuell nach Stentthrombose- und Blutungsrisiko bei dem jeweiligen Patienten getroffen werden sollte.

Schlüsselwörter

Orale Antikoagulation Stent Stentthrombose Thrombozytenhemmung Blutungen 

Antithrombotic therapy in patients with the need for oral anticoagulation and coronary stent implantation

Abstract

Patients with coronary stent implantation are treated with dual antiplatelet therapy with aspirin and a thienopyridine. This combination therapy reduced the rate of early stent thrombosis and allowed the widespread use of coronary stents, which are currently implanted in about 90% of patients with PCI. In patients with bare metal stents, the recommended duration of dual antiplatelet therapy is 4 weeks, while 6–12 months is recommended in patients with drug-eluting stents. However, problems arise in patients needing oral anticoagulation. Combination therapy with oral anticoagulation and antiplatelet therapy is associated with an increase in bleeding complications. So far no randomized studies have defined the optimal intensity and duration of antithrombotic therapy in these patients. Therefore the decision should be made based on an individual risk assessment for stent thrombosis and bleeding in each patient.

Key words

drug eluting stent antiplatelet therapy stent thrombosis oral anticoagulation bleedings 

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Copyright information

© Springer Medizin Verlag 2009

Authors and Affiliations

  1. 1.Klinikum Ludwigshafen, Medizinische Klinik BInstitut für Herzinfarktforschung Ludwigshafen an der Universität HeidelbergLudwigshafen am RheinGermany

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