Diabetes und kardiovaskuläre Ereignisse

 

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ZUSAMMENFASSUNG

Bei Diabetes kommt es in Abhängigkeit von Dauer und Einstellung zu zahlreichen hämostaseologischen Veränderungen, die in einen prothrombotischen Status resultieren und zur hohen kardiovaskulären Ereignisrate beitragen. Zur Reduktion der Ereignisrate wird eine prophylaktische Gabe von Acetylsalicylsäure (ASS) diskutiert. Entscheidend ist dabei ein positiver Nettoeffekt, dies bedeutet, dass mehr kardiovaskuläre Ereignisse verhindert als Blutungen verursacht werden. Nach einem kardialen Ereignis ist das ischämische Risiko deutlich höher, sodass die Kombination aus 2 Thrombozyteninhibitoren (DAPT) für eine begrenzte Dauer verschrieben wird. Bei besonders hohem Risiko und niedrigem Blutungsrisiko kann die DAPT fortgesetzt oder eine Dual-Pathway Therapie mit ASS und niedrig dosiertem Rivaroxaban eingesetzt werden. Bei gleichzeitigem Vorliegen von Vorhofflimmern steht die Fortsetzung der oralen Antikoagulation mit einem NOAK (Neue orale Antikoagulanzien) im Vordergrund und die Thrombozyteninhibitortherapie wird in deutlich reduzierter Dauer und Intensität empfohlen.

Publication History

Article published online:
19 August 2022

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• Literatur

• 1 Joseph JJ, Deedwania P, Acharya T. et al AHA SCIENTIFIC STATEMENT Comprehensive Management of Cardiovascular Risk Factors for Adults With Type 2 Diabetes: A Scientific Statement From the American Heart Association. Circulation 2022; 145: e722-e759
  CrossrefPubMedGoogle Scholar
• 2 Ajjan RA, Kietsiriroje N, Badimon L. et al Antithrombotic therapy in diabetes: which, when, and for how long. Eur Heart J 2021; 42: 2235-2259
  CrossrefPubMedGoogle Scholar
• 3 Kim HK, Kim JE, Park SH. et al High coagulation factor levels and low protein C levels contribute to enhanced thrombin generation in patients with diabetes who do not have macrovascular complications. J Diabetes Complications 2014; 28: 365-369
  CrossrefPubMedGoogle Scholar
• 4 Kearney K, Tomlinson D, Smith K. et al Hypofibrinolysis in diabetes: a therapeutic target for the reduction of cardiovascular risk. Cardiovasc Diabetol 2017; 16: 34
  CrossrefPubMedGoogle Scholar
• 5 Alzahrani SH, Ajjan RA. Coagulation and fibrinolysis in diabetes. Diab Vasc Dis Res 2010; 07: 260-273
  CrossrefPubMedGoogle Scholar
• 6 Du XL, Edelstein D, Rossetti L. et al Hyperglycemia-induced mitochondrial superoxide overproduction activates the hexosamine pathway and induces plasminogen activator inhibitor-1 expression by increasing Sp1 glycosylation. Proc Natl Acad Sci USA 2000; 97: 12222-12226
  CrossrefPubMedGoogle Scholar
• 7 Rocca B, Santilli F, Pitocco D. et al The recovery of platelet cyclooxygenase activity explains interindividual variability in responsiveness to low-dose aspirin in patients with and without diabetes. J Thromb Haemost 2012; 10: 1220-1230
  CrossrefPubMedGoogle Scholar
• 8 James S, Angiolillo DJ, Cornel JH. et al Ticagrelor vs. clopidogrel in patients with acute coronary syndromes and diabetes: a substudy from the PLATelet inhibition and patient Outcomes (PLATO) trial. Eur Heart J 2010; 31: 3006-3016
  CrossrefPubMedGoogle Scholar
• 9 Ducrocq G, Wallace JS, Baron G. et al Risk score to predict serious bleeding in stable outpatients with or at risk of atherothrombosis. Eur Heart J 2010; 31: 1257-1265
  CrossrefPubMedGoogle Scholar
• 10 Lemesle G, Meurice T, Tricot O. et al Association of diabetic status and glycemic control with ischemic and bleeding outcomes in patients with stable coronary artery disease: the 5-Year CORONOR Registry. J Am Heart Assoc 2018; 07: e008354
  CrossrefPubMedGoogle Scholar
• 11 Goel N, Jain D, Haddad DB. et al Anticoagulation in patients with end-stage renal disease and atrial fibrillation: confusion, concerns and consequences. J Stroke 2020; 22: 306-316
  CrossrefPubMedGoogle Scholar
• 12 Capodanno D, Angiolillo DJ. Aspirin for primary cardiovascular risk prevention and beyond in diabetes mellitus. Circulation 2016; 134: 1579-1594
  CrossrefPubMedGoogle Scholar
• 13 Baigent C, Blackwell L, Collins R. et al Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 2009; 373: 1849-1860
  CrossrefPubMedGoogle Scholar
• 14 Seidu S, Kunutsor SK, Sesso HD. et al Aspirin has potential benefits for primary prevention of cardiovascular outcomes in diabetes: updated literature-based and individual participant data meta-analyses of randomized controlled trials. Cardiovasc Diabetol 2019; 18: 70
  CrossrefPubMedGoogle Scholar
• 15 The ASCEND Study Collaborative Group Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus. N Engl J Med 2018; 379: 1529-1539
  CrossrefPubMedGoogle Scholar
• 16 Steg PG, Bhatt DL, Simon T. et al THEMIS Steering Committee and Investigators. Ticagrelor in patients with stable coronary disease and diabetes. N Engl J Med 2019; 381: 1309-1320
  CrossrefPubMedGoogle Scholar
• 17 Cosentino F, Grant PJ, Aboyans V. et al ESC Scientific Document Group. 2019. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J 2020; 41: 255-323
  CrossrefPubMedGoogle Scholar
• 18 Neumann FJ, Sousa-Uva M, Ahlsson A. et al 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 2019; 40: 87-165
  CrossrefPubMedGoogle Scholar
• 19 Aspirin Twice a Day in Patients With Diabetes and Acute Coronary Syndrome (ANDAMAN). ClinicalTrials.gov Identifier: NCT02520921
• 20 Wiviott SD, Braunwald E, Angiolillo DJ. et al Greater Clinical Benefit of More Intensive Oral Antiplatelet Therapy With Prasugrel in Patients With Diabetes Mellitus in the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel-Thrombolysis in Myocardial Infarction 38. Circulation 2008; 118: 1626-1636
  CrossrefPubMedGoogle Scholar
• 21 Franchi F, James SK, Lakic TG. et al Impact of Diabetes Mellitus and Chronic Kidney Disease on Cardiovascular Outcomes and Platelet P2Y12 Receptor Antagonist Effects in Patients With Acute Coronary Syndromes: Insights From the PLATO Trial. J Am Heart Assoc 2019; 08: e011139
  CrossrefPubMedGoogle Scholar
• 22 Schüpke S, Neumann FJ, Menichelli M. et al Ticagrelor or Prasugrel in Patients with Acute Coronary Syndromes. N Engl J Med 2019; 381: 1524-1534
  CrossrefPubMedGoogle Scholar
• 23 Mehran R, Baber U, Sharma SK. et al Ticagrelor with or without Aspirin in High-Risk Patients after PCI. N Engl J Med 2019; 381: 2032-2042
  CrossrefPubMedGoogle Scholar
• 24 Malik AH, Yandrapalli S, Shetty SS. et al Meta-analysis of Dual Antiplatelet Therapy Versus Monotherapy With P2Y12 Inhibitors in Patients After Percutaneous Coronary Intervention. Am J Cardiol 2020; 127: 25-29
  CrossrefPubMedGoogle Scholar
• 25 Bonaca MP, Bhatt DL, Cohen M. et al Long-term use of ticagrelor in patients with prior myocardial infarction. N Eng J Med 2015; 372: 1791-1800
  CrossrefPubMedGoogle Scholar
• 26 Eikelboom JW, Connolly SJ, Bosch J. et al Rivaroxaban with or without aspirin in stable cardiovascular disease. N Engl J Med 2017; 377: 1319-1330
  CrossrefPubMedGoogle Scholar
• 27 Anand SA, Eikelboom JW, Dyal L. et al Rivaroxaban plus Aspirin versus Aspirin in relation to vascular risk in the COMPASS trial. J Am Coll Cardiol 2019; 73: 3271-3280
  CrossrefPubMedGoogle Scholar
• 28 Hindricks G, Potpara T, Nikolaos Dagres. et al ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC). Eur Heart J 2021; 42: 373-498
  Google Scholar
• 29 Steffel J, Collins R, Antz M. et al 2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation. EP Europace 2021; 23: 1612-1676
  CrossrefPubMedGoogle Scholar