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Thrombozytenaggregationshemmer bei koronarer, zerebraler und peripherer Makroangiopathie

Was, wann, wie lange?

Platelet inhibition in patients with coronary, cerebral and peripheral macroangiopathy

What, when and how long?

  • Arzneimitteltherapie
  • Published:
Der Internist Aims and scope Submit manuscript

An Erratum to this article was published on 21 June 2018

This article has been updated

Zusammenfassung

Hintergrund

Die medikamentöse Inhibition der Thrombozytenaggregation kann die Rate vaskulärer Ereignisse bei Patienten mit koronarer Herzkrankheit (KHK), Karotisstenosen und symptomatischer peripherer arterieller Verschlusskrankheit (PAVK) reduzieren. Die Wahl der geeigneten Plättchenhemmer in der Mono- oder Kombinationstherapie sowie die Dauer der dualen Plättchenhemmung werden von der klinischen Situation und den individuellen Charakteristika der Patienten bestimmt.

Ziel der Übersicht

Die vorliegende Übersicht fasst die aktuelle Datenlage sowie Empfehlungen zur Plättchenhemmung bei koronarer, zerebraler und peripherer Makroangiopathie zusammen.

Datenlage

Zur Plättchenhemmung in verschiedenen klinischen Situationen liegen viele randomisierter Studien vor. Sie ermöglichen evidenzbasierte Empfehlungen zur Wahl der Substanzen und Dauer der Therapie. Darüber hinaus wurden kürzlich neue Leitlinien der europäischen Fachgesellschaften zur Plättchenhemmung bei KHK, zerebrovaskulären Erkrankungen und PAVK publiziert.

Schlussfolgerung

Auf der Basis neuer randomisierter Studien und aktualisierter Leitlinien kann eine Vielzahl von Empfehlungen zur Plättchenhemmung bei stabiler KHK, nach Stentimplantation, nach akutem Koronarsyndrom sowie bei zerebraler und peripherer arterieller Verschlusskrankheit gegeben werden.

Abstract

Background

Inhibition of platelet aggregation can reduce the rate of vascular events in patients with coronary artery disease, carotid artery stenosis and symptomatic peripheral arterial disease. The choice of platelet inhibitors in monotherapy and combination therapy as well as the duration of dual platelet inhibition depend on the clinical situation and individual patient characteristics.

Goal

The present review summarizes the latest data from clinical trials and recommendations regarding platelet inhibition in coronary, cerebral and peripheral arterial disease.

Data

A large number of randomized trials on platelet inhibition in different clinical situations have been performed, allowing evidence-based recommendations on the choice of drugs and duration of treatment. Moreover, new guidelines of European professional societies on platelet inhibition in patients with coronary, cerebral and peripheral arterial disease have been recently published.

Conclusion

Based on latest randomized trials and major society guidelines, a number of recommendations on platelet inhibition in stable coronary artery disease, after stent implantation, after acute coronary syndromes and in cerebral and peripheral arterial disease can be made.

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Change history

  • 21 June 2018

    Erratum zu:

    Internist 2018

    https://doi.org/10.1007/s00108-017-0362-5

    In der gedruckten und in der zunächst online veröffentlichten Fassung dieses Beitrags ist ein Fehler in der Darreichungsempfehlung zu Ticagrelor-Schmelztabletten im Abschnitt „Beginn der dualen Plättchenhemmung“ aufgetreten. Die …

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  1. Klinik III für Innere Medizin, Herzzentrum, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland

    M. Halbach &  S. Baldus

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  1. M. Halbach
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M. Halbach hat Vortragshonorare von AstraZeneca, Bayer, BMS/Pfizer und Daiichi Sankyo erhalten. S. Baldus hat Vortragshonorare von AstraZeneca, Bayer, BMS/Pfizer und Daiichi Sankyo erhalten.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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M. Wehling, Mannheim

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Halbach, M., Baldus, S. Thrombozytenaggregationshemmer bei koronarer, zerebraler und peripherer Makroangiopathie. Internist 59, 288–303 (2018). https://doi.org/10.1007/s00108-017-0362-5

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