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Antikoagulation bei Diabetes mellitus

Anticoagulation in patients with diabetes mellitus

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Zusammenfassung

Patienten mit Diabetes mellitus haben ein erhöhtes kardiovaskuläres Risiko und eine schlechtere Prognose bei der Manifestation von kardiovaskulären Erkrankungen. Acetylsalicylsäure (ASS) 100 mg ist zur Sekundärprophylaxe nach einem kardiovaskulären Ereignis (Schlaganfall, Herzinfarkt) indiziert, da hierdurch die Mortalität reduziert wird. Patienten mit Diabetes mellitus sind kardiovaskuläre Hochrisikopatienten (KHK-Risiko >1,5% pro Jahr); daher ist eine Medikation mit ASS auch zur Primärprophylaxe sinnvoll. Nach koronarer Stentimplantation ist für Patienten mit Diabetes die duale Plättchenhemmung aus ASS 100 mg und Clopidogrel 75 mg indiziert. Bei Verwendung eines nicht beschichteten Stents (Metallstent, „bare metal stent“) sollte sie für 4 Wochen erfolgen; bei einem medikamentös beschichteten Stent (DES, „drug eluting stent“) für mindestens 6, besser 12 Monate, um Stentthrombosen zu vermeiden. Die orale Antikoagulation ist bei Patienten mit bzw. ohne Diabetes gleich, wenn eine proliferative diabetische Retinopathie ausgeschlossen werden kann.

Abstract

Patients with diabetes mellitus have an increased cardiovascular risk (annual risk of coronary heart disease >1.5%), and in the case of a cardiovascular event, their prognosis is worse than that of nondiabetic patients. Medication with 100 mg aspirin is indicated following a cardiovascular event (stroke, myocardial infarction) for secondary prevention, as it reduces mortality, and because of diabetics’ high risk, this dose is also recommended for primary prevention. Following coronary stent implantation, dual antiplatelet therapy with 100 mg aspirin and 75 mg clopidogrel should be initiated. Dual antiplatelet therapy should be given for 4 weeks if a bare metal stent was used and should be prolonged to a minimum of 6 months (even better, 12 months) following implantation of a drug-eluting stent. Oral anticoagulation does not differ in diabetics and nondiabetics if proliferative diabetic retinopathy can be ruled out.

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  1. Klinik für Kardiologie u. Angiologie, St. Josef-Hospital, BG-Kliniken Bergmannsheil, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland

    H. Neubauer

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Neubauer, H. Antikoagulation bei Diabetes mellitus. Diabetologe 3, 469–482 (2007). https://doi.org/10.1007/s11428-007-0170-y

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