Drug Eluting Stents und Antikoagulation in der perioperativen Phase – Eine interdisziplinäre Aufgabe

 

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Zusammenfassung

Bei koronararteriellen Interventionen kardialer Risikopatienten werden zunehmend Drug Eluting Stents implantiert. Diese Stents machen eine verlängerte Antikoagulation bis zu einem Jahr oder länger erforderlich. Plättchenaggregatiosnhemmer wie Clopidogrel und Acetylsalicylsäure sollten daher, wenn möglich, in der perioperativen Phase kontinuierlich appliziert werden. Eine Unterbrechung der Plättchenaggregationshemmung sollte bei jedem Patienten individuell nur nach interdisziplinärer Absprache zwischen Chrirugen, Kardiologen und Anästhesisten erfolgen.

Summary

Drug eluting stents are nowadays more frequently used in cardiac risk patients undergoing coronary artery interventions. These stents make prolonged anticoagulation up to one year or longer necessary to avoid acute stent thrombosis. Anti–platelet drugs like clopidogrel and aspirin should therefore be continued perioperatively if possible. Decission to stop anti–plateletts should be made for each individual patient only after interdisciplinary discussion with the cardiologist, surgeon and anaesthesiologist.

Kernaussagen

• Vor einer Stent–Implantation sollte der Kardiologe die Notwendigkeit einer dualen PAH und deren Dauer von mindestens 12 Monaten bei DES mit dem Patienten besprechen.

• Patienten, die nach einer PCI innerhalb eines Jahres einem operativen oder interventionellem Eingriff unterzogen werden sollen, sollten keinen DES erhalten.

• Patienten müssen ausführlich und mit Nachdruck auf die Notwendigkeit der dualen PAH hingewiesen werden.

• Patienten sollten eindeutige Informationen über die Art des implantierten Stents erhalten.

• Patienten sollten dahingehend geschult werden, dass sie nur nach Rücksprache mit dem behandelnden Kardiologen die PAH unterbrechen.

• Ärzte aller Fachgebiete, die invasive oder operative Eingriffe durchführen, müssen für die potenziell katastrophalen Folgen einer PAH–Unterbrechung sensibilisiert werden. Bei Unklarheiten bezüglich der PAH sollte die optimale perioperative Therapie mit dem Kardiologen besprochen werden, der den Patienten behandelt.

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PD Dr. Benedikt Preckel
Prof. Dr. Wolfgang Schlac

Email: b.preckel@amc.uva.nl

Email: w.s.schlack@amc.uva.nl

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