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Notfall + Rettungsmedizin

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01.11.2007 | Leitthema

Frühe Antiplättchentherapie und Gerinnungshemmung bei akutem Koronarsyndrom

Hintergrund und aktuelle Studienlage

verfasst von: Prof. Dr. H.R. Arntz

Erschienen in: Notfall + Rettungsmedizin | Ausgabe 7/2007

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Zusammenfassung

Die antithrombozytäre und antikoagulatorische Therapie bei akutem Koronarsyndrom (AKS) entwickelt sich mit kaum noch zu überblickender Dynamik als Folge der Verfügbarkeit neuer Substanzen, neuer Kombinationen und neuer Therapiestrategien. Die vielfältigen möglichen Kombinationen gerinnungshemmender Pharmaka sind noch lange nicht alle erprobt und bieten Chancen zu weiterem Fortschritt. Demgegenüber steht das Problem eines steigenden Blutungsrisikos, das in vielen Fällen den Nutzen hinsichtlich der Vermeidung insbesondere früher koronarer Rezidivereignisse zumindest teilweise aufzuheben droht. Besonders stark erhöhte Blutungsrisiken fanden sich z. B. beim Einsatz von Glykoprotein-IIb/IIIa-Rezeptorblockern in Kombination mit Thrombolytika (v. a. Streptokinase) oder hochdosiertem Enoxaparin bei älteren weiblichen Patienten mit geringem Körpergewicht. Im Gegensatz dazu steigert Clopidogrel in der Akuttherapie die Blutungsrisiken wenn überhaupt nur unwesentlich und ist auch langfristig eine Schlüsseltherapie bei AKS. Vorsichtige Therapieansätze mit reduzierten, risikoangepassten Dosierungen bei Patienten über 75 Jahren und solchen mit deutlich eingeschränkter Nierenfunktion, die beispielhaft in der EXTRACT-TIMI-25-Studie für Enoxaparin gezeigt werden, sind geeignet, den langen Weg bis zu einer optimalen gerinnungshemmenden Behandlung bei akutem Koronarsyndrom zu sichern.

Vorheriger Artikel Präklinische Intubation bei Trauma

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Titel: Frühe Antiplättchentherapie und Gerinnungshemmung bei akutem Koronarsyndrom
Hintergrund und aktuelle Studienlage
verfasst von: Prof. Dr. H.R. Arntz
Publikationsdatum: 01.11.2007
Verlag: Springer-Verlag
Erschienen in: Notfall + Rettungsmedizin / Ausgabe 7/2007
Print ISSN: 1434-6222
Elektronische ISSN: 1436-0578
DOI: https://doi.org/10.1007/s10049-007-0939-y

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