Zusammenfassung
Die duale thrombozytenaggregationshemmende Therapie – bestehend aus Acetylsalicylsäure und einem Thienopyridin (meist Clopidogrel) – ist essenziell bei Patienten nach perkutaner Koronarintervention mit Stentimplantation. Hiermit kann eine Stentthrombose und ihre in einer Vielzahl der Fälle tödlichen Folgen effektiv vermieden werden. Auf der anderen Seite geht diese Therapie mit einer erhöhten Rate von Blutungskomplikationen einher. Im Falle notwendiger dringlicher oder notfallmäßiger Operationen muss daher das Risiko einer perioperativen Stentthrombose gegen das operationsassoziierte Blutungsrisiko abgewogen und die Zeit ohne suffiziente Thrombozytenaggregation so kurz wie möglich gehalten werden.
Der vorliegende Fall beschreibt eine Strategie zum perioperativen Management thrombozytenaggregationshemmender Medikamente.
Abstract
Dual antiplatelet therapy using aspirin and a thienopyridine (e.g. clopidogrel) is known to be essential in patients in whom percutaneous coronary intervention with stent implantation has been performed in order to prevent stent thrombosis and its fatal consequences. On the other hand dual antiplatelet therapy increases the incidence of perioperative bleeding complications. In case of urgent or emergency surgery the risk of perioperative stent thrombosis on the one hand and the perioperative bleeding risk on the other has to be evaluated carefully in order to keep time period without sufficient platelet inhibition as short as possible.
The presented case offers a strategy for managing perioperative administration of antiplatelet agents.
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Vogt, A., Schlitt, A., Buerke, M. et al. Diagnostische Laparoskopie unter doppelter thrombozytenaggregationshemmender Therapie mit Clopidogrel und ASS. Med Klin 106, 48–52 (2011). https://doi.org/10.1007/s00063-011-0026-5
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DOI: https://doi.org/10.1007/s00063-011-0026-5