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Update orale Plättchenhemmer

Positionspapier der deutschen Gesellschaft für Kardiologie

Update on oral platelet inhibitors

Position paper of the German Society for Cardiology

  • Positionspapier
  • Published:
Der Kardiologe Aims and scope

An Erratum to this article was published on 05 August 2012

Zusammenfassung

Eine zuverlässige und langfristige duale Plättchenhemmung bei der Behandlung von Patienten mit koronarer Stentimplantation und Patienten mit akuten Koronarsyndromen ist zur Vermeidung schwerwiegender thrombotischer Ereignisse und lebensbedrohlicher Stentthrombosen erforderlich. Neu entwickelte medikamentöse Therapieoptionen sowie gesundheitspolitische Gegenpositionen zu Therapiealgorithmen internationaler Fachgesellschaften führen zur öffentlichen Verunsicherung. Entsprechend den Leitlinien der Fachgesellschaften (ESC und AHA/ACC) muss die duale Plättchenhemmung nach akutem Koronarsyndrom („acute coronary syndrome“, ACS) unabhängig von der Akuität (STEMI oder N-STEMI) und der primären Therapie für mindestens 12 Monate bei fehlenden Kontraindikationen durchgeführt werden. Unter Abwägung des Blutungsrisikos sind neuere P2Y12-Rezeptorantagonisten (Prasugrel, Ticagrelor) beim ACS nach aktuellen Leitlinien vorzuziehen. Nach elektiver Implantation unbeschichteter Koronarstents sollte Clopidogrel (Clopidogrel-Hydrogensulfat) für einen Monat und nach medikamentenfreisetzenden Stents für mindestens 6 Monate und in Abhängigkeit vom individuellen Risikoprofil für optimal 12 Monate verabreicht werden.

Abstract

A reliable and long-term dual platelet inhibition for the treatment of patients undergoing coronary stent implantation and patients with acute coronary syndrome is necessary for avoidance of severe thrombotic events and life-threatening stent thromboses. Newly developed pharmacologic options and health political opposition to therapeutic algorithms of international societies lead to public uncertainty. In accordance with the guidelines of specialist societies, such as the European Society of Cardiology (ESC) and the American Heart Association/American College of Cardiology (AHA/ACC) dual platelet inhibition following acute coronary syndrome (ACS) must be carried out for at least 12 months independent of the acuteness (STEMI or N-STEMI) and the primary therapy when there are no contraindications. According to current guidelines new P2Y12 receptor antagonists (prasugrel, ticagrelor) should be given preference for ACS taking the risk of hemorrhage into consideration. After elective implantation of uncoated (bare metal) coronary stents clopidogrel (clopidogrel hydrogen sulfate) should be administered for 1 month, for drug-eluting stents for at least 6 months and for optimally 12 months depending on the individual risk profile.

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Interessenkonflikt

Die korrespondierenden Autoren weisen auf folgende Beziehungen hin: TG: Vortragshonorare Eli Lilly/Daiichi Sankyo, The Medicines Company, Bayer Health Care; projektbezogener Grant: Eli Lilly/Daiichi Sankyo.

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  1. Abteilung für Kardiologie und Kreislauferkrankungen, Medizinische Klinik III, Universitätsklinikum Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland

    M. Gawaz &  T. Geisler

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  2. T. Geisler
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Gawaz, M., Geisler, T. Update orale Plättchenhemmer. Kardiologe 6, 195–209 (2012). https://doi.org/10.1007/s12181-012-0419-6

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