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Thrombozytenhemmung beim alten Menschen

Platelet inhibition in elderly patients

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Zusammenfassung

Die singuläre antithrombozytäre Therapie (SAPT) mit überwiegend Acetylsalicylsäure (ASS) ist die antithrombotische Basistherapie sowohl in der Primär- als auch in der Sekundärprävention atherosklerotischer Erkrankungen. Die duale antithrombozytäre Therapie (DAPT) ist ein Eckpfeiler der Nachbehandlung interventionell versorgter Patienten sowohl nach elektiver Koronarintervention als auch nach einem akuten Koronarsyndrom (ST-Hebungs-Infarkt, Nicht-ST-Hebungs-Infarkt, instabile Angina Pectoris). In den vergangenen Jahren wurde besonders die Dauer einer DAPT diskutiert. Aktuelle Empfehlungen wie zuletzt das Focused Update DAPT 2017 der Europäischen Gesellschaft für Kardiologie (ESC) widmen sich auch den Strategien zur Reduzierung eines erhöhten Blutungsrisikos aufgrund klinischer Prädiktoren. Höheres Alter ist hierbei ein wichtiger blutungsrelevanter Faktor. Im vorliegenden Artikel wird die Evidenz zu SAPT und DAPT insbesondere bei Patienten mit einem Alter ab 75 Jahren betrachtet.

Abstract

Single antiplatelet therapy (SAPT) using predominantly acetylsalicylic acid (ASA) is the baseline anti-thrombotic therapy in primary as well as secondary prevention of atherosclerotic disease. Dual antiplatelet therapy (DAPT) is the cornerstone of maintenance medication following elective percutaneous coronary interventions or acute coronary syndromes (ST elevation myocardial infarction, non-ST elevation myocardial infarction and unstable angina pectoris). In the past the duration of DAPT in particular has been frequently discussed. Current recommendations, such as the “Focused Update DAPT 2017” of the European Society of Cardiology (ESC) emphasize the importance of strategies aiming to reduce an increased risk of bleeding based on clinical predictors. In this case older age is an important factor relevant for bleeding. In this article, the evidence for SAPT or DAPT is summarized with a special focus on patients aged ≥75 years.

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Authors and Affiliations

  1. Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30659, Hannover, Deutschland

    A. Schäfer & J. Bauersachs

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  1. A. Schäfer
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  2. J. Bauersachs
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Correspondence to A. Schäfer.

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A. Schäfer hat für folgende Firmen Vorträge gehalten oder diese beraten: Daiichi-Sankyo, BMS/Pfizer, Boehringer Ingelheim, Bayer. J. Bauersachs hat für folgende Firmen Vorträge gehalten oder diese beraten: Daiichi-Sankyo, BMS/Pfizer, Boehringer Ingelheim, Bayer, AstraZeneca.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Schäfer, A., Bauersachs, J. Thrombozytenhemmung beim alten Menschen. Herz 43, 222–229 (2018). https://doi.org/10.1007/s00059-017-4657-z

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