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Antithrombotic therapy in patients with coronary artery disease and with type 2 diabetes mellitus

Antithrombotische Therapie bei Patienten mit koronarer Herzkrankheit und Typ2 Diabetes mellitus

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Zusammenfassung

Die koronare Herzerkrankung (KHK) ist die führende Mortalitätsursache bei Patienten mit Diabetes mellitus (DM). Die Langzeitprognose des Diabetikers ohne Myokardinfarkt-Anamnese ist vergleichbar mit der eines Patienten, der einen Myokardinfarkt (MI) bereits durchgemacht hat, aber keinen DM hat. Der Antiplättchen-Therapie bei Patienten mit einer KHK und DM kommt eine zentrale Rolle zu, wobei dem ADP-Rezeptorblocker Prasugrel eine größere Effizienz zugeschrieben wird im Vergleich zu Clopidogrel und Ticlopidin. Patienten mit DM und akuten Koronarsyndrom (ACS), die einer interventionellen Therapie unterzogen werden, profitieren mehr von eine additiven Therapie mit Glycoprotein IIb/IIIa-Inhibitoren als Patienten ohne DM. Weiters kommen verschiedene, direkte und indirekte Antithrombine in der Therapie des ST-Hebungs-Infarktes (STEMI) und nicht ST-Hebungs-Infarktes (NSTEMI) zur Anwendung. Unter diesen Medikamenten haben sich sowohl das niedermoleklare Heparin Enoxaparin als auch der direkte Thrombin-Inhibitor Bivalirudin als sicher und effizient bei Diabetikern im Vergleich zu unfraktionierten Heparin erwiesen.

Summary

Diabetes mellitus (DM) is a life-threatening disease. Patients with DM have a 2- to 4-fold higher risk of developing cardiovascular disease compared to their non-diabetic counterparts. Several drugs are available for the treatment of stable coronary artery disease (CAD) and acute coronary syndrome (ACS). Among oral antiplatelet agents (acetylsalicylic acid, ticlopidine, clopidogrel, and prasugrel), prasugrel has shown the highest efficacy in patients with DM and ACS. The use of glycoprotein IIb–IIIa receptor inhibitors in diabetic subjects with ACS undergoing percutaneous coronary intervention (PCI) reduces adverse clinical events in a greater extent than in non-diabetics. Several direct and indirect antithrombins are recommended for the treatment of ACS such as unfractionated heparin (UFH), enoxaparin, fondaparinux, and bivalirudin. Enoxaparin and bivalirudin have been shown to be superior to UFH among patients with ST-elevation MI (STEMI) and non-ST elevation MI (NSTEMI) also in diabetic subgroup analyses.

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Authors and Affiliations

  1. Third Department of Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria

    Serdar Farhan, Thomas Höchtl & Kurt Huber

  2. Third Department of Endocrinology and Metabolism, University of Medicine, Vienna, Austria

    Alexandra Kautzky-Willer

  3. Second Department of Cardiology, University of Medicine, Vienna, Austria

    Johann Wojta

Authors
  1. Serdar Farhan
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  2. Thomas Höchtl
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  3. Alexandra Kautzky-Willer
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  4. Johann Wojta
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  5. Kurt Huber
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Correspondence to Serdar Farhan.

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Farhan, S., Höchtl, T., Kautzky-Willer, A. et al. Antithrombotic therapy in patients with coronary artery disease and with type 2 diabetes mellitus. Wien Med Wochenschr 160, 30–38 (2010). https://doi.org/10.1007/s10354-010-0747-8

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  • DOI: https://doi.org/10.1007/s10354-010-0747-8

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