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DOI: 10.1055/a-2232-5308
Management der medikamentösen Therapie vor und nach nicht kardialen Eingriffen
Management of Drug Therapy before and after Non-cardiac Interventions
Zusammenfassung
Die präoperative Risikominderung bei Patienten mit kardiovaskulären Erkrankungen ist von großer Bedeutung, um operative Eingriffe sicher durchzuführen und perioperative Komplikationen zu minimieren. Patienten mit vorbestehenden kardiovaskulären Erkrankungen haben ein erhöhtes Risiko für unerwünschte Ereignisse während und nach der Operation, einschließlich thromboembolischer Ereignisse, z. B. Herzinfarkt, Blutungskomplikationen, Herzrhythmusstörungen und kardiale Dekompensation. Die Optimierung von Risikofaktoren wie Bluthochdruck, Hyperlipidämie und Raucherentwöhnung bilden den Eckpfeiler der präoperativen Risikominimierung. Der leitlinienkonforme Einsatz pharmakologischer Maßnahmen wie Betablocker, Statine und Thrombozytenaggregationshemmer wird im Zusammenhang mit der Abwägung des potenziellen Nutzens gegen die damit verbundenen Risiken erörtert. Zusammenfassend ist ein auf den Patienten zugeschnittener, evidenzbasierter Ansatz, der sich mit kardiovaskulären Risikofaktoren befasst und das medizinische Management optimiert, der Eckpfeiler der präoperativen Betreuung und verbessert letztlich die chirurgischen Ergebnisse und die Prognose des Patienten.
Abstract
Preoperative risk reduction in patients with cardiovascular diseases is of paramount importance to ensure safe surgical outcomes and minimize perioperative complications. Patients with preexisting cardiovascular conditions face an increased risk of adverse events during and after surgery, including thromboembolic events e.g. myocardial infarction, bleeding complications, arrhythmias, and heart failure. Optimization of modifiable risk factors such as hypertension, diabetes, hyperlipidemia, and smoking cessation forms the cornerstone of preoperative risk reduction. The judicious use of pharmacological interventions, such as beta-blockers, statins, and antiplatelet agents, is explored in the context of balancing potential benefits against associated risks. In conclusion, a patient-tailored, evidence-based approach that addresses cardiovascular risk factors and optimizes medical management forms the cornerstone of preoperative care, ultimately enhancing surgical outcomes and patients prognosis.
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Es finden 22 Millionen Operationen in der Europäischen Union pro Jahr statt, davon 85% nicht kardiale Operationen.
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Eine Nikotinkarenz senkt das perioperative Ereignisrisiko um 19% pro Woche des präoperativ pausierten Rauchens. Eine Statintherapie sollte fortgeführt werden. Die präoperative Initiierung einer Statintherapie wird nicht empfohlen.
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Wichtig ist die präoperative Abwägung von Blutungsrisiken durch die OP und/oder eingenommene Antikoagulanzien und dem Risiko für kardiovaskuläre Ereignisse:
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Antikoagulanzien sollten in Abhängigkeit vom perioperativen Blutungsrisiko fortgeführt werden. Ein Bridging ist nur bei hohem Risiko für thromboembolische Ereignisse indiziert.
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Thrombozytenaggregationshemmer sollten in Abhängigkeit von der Indikation zur stattgehabten perkutanen Koronarintervention fortgeführt werden oder in enger Rücksprache mit Kardiologen zeitgerecht pausiert bzw. die nicht kardiale Operation verschoben werden.
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Publication History
Article published online:
08 February 2024
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