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Koronare Stents, duale Antiplättchentherapie und die perioperative Problematik

Coronary stents, dual antiplatelet therapy and peri-operative problems

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Zusammenfassung

Bei perkutaner koronarer Intervention werden in bis zu 90% der Fälle Koronarstents implantiert. Sie erfordern typabhängig eine duale Antiplättchentherapie (Clopidogrel und Acetylsalicylsäure). Die Therapiedauer liegt bei 3–4 Wochen bzw. 6–12 Monaten bei Bare-Metal- bzw. Drug-Eluting-Stents. Absetzen der dualen Antiplättchentherapie erhöht das Risiko einer Stentthrombose, ihre Weiterführung das einer relevanten Blutung im Operationsgebiet. Das perioperative Vorgehen stützt sich auf Empfehlungen anästhesiologischer und kardiologischer Gesellschaften. Bei Eingriffen mit hohem Blutungsrisiko kann von chirurgischer Seite ein Absetzen beider Substanzen erforderlich sein, bei hohem Thromboserisiko sollten beide Medikamente, zumindest aber Acetylsalicylsäure, bis zum Operationstag gegeben werden. Für die Durchführung einer Regionalanästhesie existieren Empfehlungen von nationalen Gesellschaften. Patienten, die nach koronarer Stentimplantation unter dualer Antiplättchentherapie stehen, profitieren von einer interdisziplinären Betreuung durch Anästhesiologen, Operateur und Kardiologen.

Abstract

Up to 90% of all percutaneous coronary interventions include coronary artery stenting. Dual antiplatelet therapy, usually involving acetylsalicyl acid combined with clopidogrel, is mandatory for patients with coronary artery stents. The duration of antiplatelet therapy for bare metal stents is 3–4 weeks, for drug eluting stents 6–12 months. Preoperative discontinuation of both drugs increases the risk of stent thrombosis, continuation the risk of relevant bleeding. According to the recommendations of anaesthesiological and cardiological societies, perioperative management has to balance the risk of bleeding vs stent thrombosis. Surgery involving a high risk of bleeding can require the discontinuance of both substances. In cases of high thrombosis risk, at least the acetylsalicyl acid should be continued until the day of surgery. For patients under antiplatelet therapy scheduled for local anaesthesia, national recommendations exist. A close collaboration between the anaesthesiologist, cardiologist and surgeon is essential for appropriate pre-, intra- and postoperative management.

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Authors and Affiliations

  1. Universitätsklinik für Anästhesiologie und Intensivmedizin, Medizinische Universität Graz, Auenbruggerplatz 29, 8036 , Graz, Österreich

    H. Metzler, M.N. Vicenzi & A. Münch

  2. 3. Medizinische Abteilung mit Kardiologie und internistischer Notaufnahme, Wilhelminenspital, Wien, Österreich

    K. Huber

  3. Universitätsklinik für Allgemeine Anästhesie und Intensivmedizin B, Medizinische Universität Wien, Wien, Österreich

    S. Kozek-Langenecker

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  1. H. Metzler
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  2. K. Huber
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  3. S. Kozek-Langenecker
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  4. M.N. Vicenzi
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  5. A. Münch
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Correspondence to H. Metzler.

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Metzler, H., Huber, K., Kozek-Langenecker, S. et al. Koronare Stents, duale Antiplättchentherapie und die perioperative Problematik. Anaesthesist 56, 401–412 (2007). https://doi.org/10.1007/s00101-007-1171-3

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