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Gibt es eine optimale Dauer?

Duale Plättcheninhibition nach Stentimplantation: kürzer oder länger

  • Schwerpunkt_Kardiologie
  • Published:
CardioVasc Aims and scope

Zusammenfassung

Die optimale Dauer der dualen antithrombozytären Therapie nach Implantation von medikamentenbeschichteten Koronarstents (DES) ist eine der großen ungelösten Fragen in der modernen Kardiologie. Kürzlich sind einige wichtige Studien zu diesem Thema vorgestellt worden. Eine klare Antwort für alle Patienten können diese jedoch nicht liefern. Die mit 9.961 randomisierten DES-Patienten bislang größte DAPT-Studie hat gezeigt, dass eine Verlängerung der Therapie auf 30 Monate nach Stentimplantation im Vergleich zu 12 Monaten einen Vorteil bezüglich ischämischer Ereignisse, insbesondere Stentthrombose und Myokardinfarkt, bringt. Dies wurde allerdings mit einem erhöhten Blutungsrisiko erkauft. Zudem war die Gesamtmortalität in der Gruppe mit der verlängerten Therapie erhöht, was die Interpretation der Ergebnisse für die klinische Praxis erschwert. Andererseits haben eine Reihe von Studien wie die ISAR-SAFE-Studie gezeigt, dass auch eine Verkürzung der Therapie auf 6 Monate bezüglich ischämischer Ereignisse sicher ist, insbesondere bei der Verwendung von DES der neuen Generation, und die kürzere Therapie mit reduziertem Blutungsrisiko einhergeht. So gibt es Vorteile sowohl für die kurze (6 Monate) als auch die lange (30 Monate) duale antithrombozytäre Therapie nach DES-Implantation. Dabei sind individuelle Faktoren (Blutungsrisiko vs. Risiko ischämischer Ereignisse) für die Therapie wohl ausschlaggebend.

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Authors and Affiliations

  1. Deutsches Herzzentrum München, Technische Universität, München, Deutschland

    Stefanie Schüpke Reents & Adnan Kastrati

  2. DZHK, Partner Site Munich Heart Alliance, München, Deutschland

    Stefanie Schüpke Reents & Adnan Kastrati

  3. ISAResearch Center, Deutsches Herzzentrum München, Lazarettstr. 36, 80636, München, Deutschland

    Stefanie Schüpke Reents

Authors
  1. Stefanie Schüpke Reents
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  2. Adnan Kastrati
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Correspondence to Stefanie Schüpke Reents.

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Reents, S., Kastrati, A. Duale Plättcheninhibition nach Stentimplantation: kürzer oder länger. CV 15, 41–44 (2015). https://doi.org/10.1007/s15027-015-0599-7

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  • DOI: https://doi.org/10.1007/s15027-015-0599-7

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