Antithrombotische Therapie bei peripherer arterieller Verschlusskrankheit

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Antithrombotische Therapie bei stabiler PAVK Die aktuellen deutschen und europäischen Leitlinien empfehlen bei Patienten mit einer peripheren arteriellen Verschlusskrankheit (PAVK) die Monotherapie mit einem Thrombozytenaggregationshemmer (ASS 100 mg oder Clopidogrel 75 mg).

In der COMPASS (Cardiovascular OutcoMes for People using Anticoagulation StrategieS) -Studie wurde Patienten mit PAVK 2 × 2,5 mg Rivaroxaban zusätzlich zu ASS 100 mg gegeben. Dies führte zur signifikanten Reduktion kardiovaskulärer Ereignisse (MACE = Major Adverse Cardiovascular Events) wie kardiovaskulärer Tod, Myokardinfarkt und Schlaganfall. Ebenfalls signifikant reduziert wurden periphere Ereignisse (MALE = Major Adverse Limb Events) wie ischämiebedingte Major-Amputation und eine akute schwere Ischämie.

Liegt bei Patienten mit einer PAVK die Indikation zur oralen Antikoagulation vor (z. B. bei Vorhofflimmern), empfehlen die aktuellen deutschen und europäischen Leitlinien die Monotherapie mit oralen Antikoagulantien ohne zusätzliche Thrombozytenaggregationshemmung.

Antithrombotische Therapie nach peripherer Revaskularisation Nach peripherer Intervention wird in Analogie zur Koronarintervention meist passager eine duale Plättchenhemmung durchgeführt. Nach peripherer Bypass-Anlage wird in der Regel die Monotherapie mit einem Thrombozytenaggregationshemmer empfohlen. In Einzelfällen kann bei komplexem Venenbypass eine orale Antikoagulation und bei Kunststoffbypass eine duale Plättchenhemmung eingesetzt werden.

Abstract

Patients with peripheral artery disease are at high-risk for cardiovascular events. Anti-thrombotic treatment is very important for secondary prevention. In symptomatic patients single antiplatelet therapy with clopidogrel or Aspirin is recommended. After peripheral revascularisation transient dual antiplatelet therapy is widely used although there is only little evidence. Following peripheral bypass surgery most patients are treated with single antiplatelet therapy, in some cases (prostetic bypass grafts) dual antiplated therapy can be useful and selected patients with complex venous grafts might profit from anticoagulation with vitamin K antagonists.

The recent publication of the COMPASS (Cardiovascular OutcoMes for People Using Anticoagulation StrategieS) study showed relevant reduction of MACE (Major Adverse Cariac Events) and MALE (Major Adverse Limb Events) for the combined therapy of rivaroxaban 2 × 2,5 mg compared to Aspirin 100 mg with increased risk for gastrointestinal bleeding. In the current VOYAGER PAD (Vascular Outcomes Study of Aspirin along with Rivaroxaban in Endovascular or Surgical Limb Revascularization for PAD) study this concept is tested after peripheral revascularisation.

Schlüsselwörter

Periphere arterielle Verschlusskrankheit - Thrombozytenaggregationshemmung - Antikoagulation

Key words

peripheral artery disease - antiplatelet therapy - anticoagulation

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