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Dtsch Med Wochenschr 2016; 141(15): 1107-1111
DOI: 10.1055/s-0042-106944
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© Georg Thieme Verlag KG Stuttgart · New York

Interdisziplinäres Management von Blutungen unter dualer antithrombozytärer Therapie nach akutem Koronarsyndrom

Bleeding in patients receiving dual antiplatelet therapy after acute coronary syndrome – significance, prevention and interdisciplinary management
U. Zeymer
1   Herzzentrum Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen
,
J. Koscielny
2   Institut für Transfusionsmedizin, Charité, Universitätsmedizin Berlin
,
C. von Heymann
3   Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerzmedizin, Vivantes Klinikum im Friedrichshain, Berlin
,
M. Spannagl
4   Abteilung für Transfusionsmedizin und Hämostaseologie, Klinikum der Universität Münche
,
J. Labenz
5   Diakonie Klinikum GmbH, Jung-Stilling Krankenhaus, Abteilung Innere Medizin, Siegen
,
J. Cremer
6   Klinik für Herz- und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
,
E. Giannitsis
7   Innere Medizin III, Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg
,
H. Darius
8   Kardiologie, Angiologie, Nephrologie und konservative Intensivmedizin, Vivantes Klinikum Neukölln, Berlin
,
F. Goss
9   Herzzentrum Alter Hof, München
› Author Affiliations
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Publication History

Publication Date:
27 July 2016 (online)

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Zusammenfassung

Zur Sekundärprophylaxe eines akuten Koronarsyndroms (ACS) wird die duale antithrombozytäre Therapie (DAPT) mit Acetylsalicylsäure und einem P2Y12-Adenosindiphosphat-Rezeptorblocker wie Clopidogrel, Prasugrel und Ticagrelor für eine Dauer von 12 Monaten in den Leitlinien empfohlen. Ein frühzeitiges Absetzen der DAPT ist mit einem erhöhten Risiko für ischämische Ereignisse verbunden. Die antithrombozytäre Therapie ist allerdings auch mit einem erhöhten Risiko für Blutungen assoziiert, welches nicht unter- aber auch nicht überschätzt werden sollte. Um eine optimale Versorgung der Patienten unter DAPT nach einem ACS zu gewährleisten, hat eine interdisziplinäre Gruppe erfahrener Experten aus den Bereichen Kardiologie, Kardiochirurgie, Gastroenterologie, Anästhesiologie, Intensivmedizin und Hämostaseologie praxisrelevante Informationen und Empfehlungen erarbeitet. Diese schließen die Bedeutung von Blutungen im Verlauf der Therapie, Maßnahmen zur Prävention und die optimale Versorgung von Patienten mit Blutungen ein.

Abstract

For secondary prevention of acute coronary syndrome, guidelines recommend dual antiplatelet therapy with acetylsalicylic acid and a P2Y12 receptor antagonist such as clopidogrel, prasugrel or ticagrelor for a period of 12 months. Premature discontinuation of dual antiplatelet therapy is associated with an increased risk of ischaemic events. However, antiplatelet therapy is also associated with an increased risk of bleeding that should not be under- or overestimated. To ensure an optimal care of patients receiving dual antiplatelet therapy after an acute coronary syndrome, an interdisciplinary group of experienced experts in the fields of cardiology, cardiac surgery, gastroenterology, anaesthesiology, intensive care and haemostaseology gathered bleeding-related information and developed recommendations relevant to daily clinical practice. These include the significance of bleeding events in the course of treatment, measures for bleeding prevention and the adequate care of patients with bleedings.

Schlüsselwörter

ADP-Rezeptorblocker - Akutes Koronarsyndrom (ACS) - Blutung - Duale Plättchenhemmung (DAPT) - Thrombozytenaggregationshemmung

Keywords

Acute coronary syndrome - Dual antiplatelet therapy - Hemorrhage - Platelet aggregation inhibitors - Purinergic P2Y receptor antagonist
 

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