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DOI: 10.1055/a-0917-8604
ASS in der Primär- und Sekundärprävention kardiovaskulärer Erkrankungen
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Der Thrombozytenaggregationshemmer Acetylsalicylsäure (ASS) ist das Medikament der Wahl in der Sekundärprophylaxe zahlreicher kardiovaskulärer Erkrankungen [1]. Hingegen ist die Relevanz von ASS in der Primärprophylaxe nicht umfassend geklärt. Dieser Review beschäftigt sich mit den Therapieoptionen von ASS in der Primär- und Sekundärprävention.
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ASS wirkt als Thrombozytenaggregationshemmer.
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Große randomisierte Studien wie ASCEND, ARRIVE und ASPREE haben die Wirksamkeit und Sicherheit von ASS in der Primärprävention untersucht.
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Die Risiken, Blutungen zu erleiden, überwiegen den potenziellen Nutzen von ASS in der Primärprävention.
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Nur nach sorgfältiger Nutzen-Risiko-Abwägung kommen einzelne Patienten für eine primärprophylaktische ASS-Therapie infrage. Kriterien hierfür sind: Diabetes mellitus, 10-Jahres-Risiko für kardiovaskuläre Ereignisse > 10%, keine Statintherapie sowie niedriges Risiko für gastrointestinale Blutungen.
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ASS 100 mg/d ist bei kardiovaskulären Hochrisikopatienten im Rahmen der Sekundärprävention indiziert und kann als Standard der Thrombozyten-hemmenden Therapie bezeichnet werden.
Publikationsverlauf
Artikel online veröffentlicht:
08. Dezember 2020
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Literatur
- 1 Patrono C, García Rodríguez LA, Landolfi R. et al. Low-Dose Aspirin for the Prevention of Atherothrombosis. N Engl J Med 2005; 353: 2373-2383
- 2 Walker J, Hutchison P, Ge J. et al. Aspirin: 120 years of innovation. A report from the 2017 Scientific Conference of the International Aspirin Foundation, 14 September 2017, Charité, Berlin. Ecancermedicalscience 2018; 12: 813
- 3 Patrignani P, Patrono C. Cyclooxygenase inhibitors: From pharmacology to clinical read-outs. Biochim Biophys Acta 2015; 4: 422-432
- 4 Patrono C. Aspirin as an antiplatelet drug. N Engl J Med 1994; 330: 1287-1294
- 5 Patrono C. The Multifaceted Clinical Readouts of Platelet Inhibition by Low-Dose Aspirin. J Am Coll Cardiol 2015; 66: 74-85
- 6 FitzGerald GA, Brash AR, Oates JA. et al. Endogenous biosynthesis of prostacyclin and thromboxane and platelet function during chronic administration of aspirin in man. J Clin Invest 1983; 71: 676-688
- 7 Patrignani P, Filabozzi P, Patrono C. Selective Cumulative Inhibition of Platelet Thromboxane Production by Low-dose Aspirin in Healthy Subjects. J Clin Invest 1982; 69: 1366-1372
- 8 Undas A, Brummel-Ziedins K, Mann KG. Why does aspirin decrease the risk of venous thromboembolism? On old and novel antithrombotic effects of acetyl salicylic acid. J Thromb Haemost 2014; 12: 1776-1787
- 9 Thun MJ, Henley SJ, Patrono C. Nonsteroidal anti-inflammatory drugs as anticancer agents: mechanistic, pharmacologic, and clinical issues. J Natl Cancer Inst 2002; 94: 252-266
- 10 Auriel E, Regev K, Korczyn AD. Nonsteroidal anti-inflammatory drugs exposure and the central nervous system. Handb Clin Neurol 2014; 119: 577-584
- 11 Bloom BS. Direct medical costs of disease and gastrointestinal side effects during treatment for arthritis. Am J Med 1988; 84: 20-24
- 12 Varghese M, Lockey RF. Aspirin-exacerbated asthma. Allergy Asthma Clin Immunol 2008; 4: 75-83
- 13 Starko KM, Ray CG, Dominguez LG. et al. Reyeʼs syndrome and salicylate use. Pediatrics 1980; 66: 859-864
- 14 Pirmohamed M, James S, Meakin S. et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ 2004; 329: 15-19
- 15 Crofford LJ. COX-1 and COX-2 tissue expression: implications and predictions. J Rheumatol Suppl 1997; 49: 15-19
- 16 Montalescot G, Sechtem U, Achenbach S. et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 2013; 34: 2949-3003
- 17 GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392: 1736-1788
- 18 Tousoulis D. What have we learned about using aspirin for primary prevention from the ASCEND and ARRIVE trials?. Cardiovasc Res 2019; 115: e15-e16
- 19 Gaziano JM, Brotons C, Coppolecchia R. et al. Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial. Lancet 2018; 392: 1036-1046
- 20 McNeil JJ, Woods RL, Nelson MR. et al. Effect of Aspirin on Disability-free Survival in the Healthy Elderly. N Engl J Med 2018; 379: 1499-1508
- 21 McNeil JJ, Wolfe R, Woods RL. et al. Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly. N Engl J Med 2018; 379: 1509-1518
- 22 McNeil JJ, Nelson MR, Woods RL. et al. Effect of Aspirin on All-Cause Mortality in the Healthy Elderly. N Engl J Med 2018; 379: 1519-1528
- 23 Ibanez B, James S, Agewall S. et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018; 39: 119-177
- 24 Rothwell PM, Cook NR, Gaziano JM. et al. Effects of aspirin on risks of vascular events and cancer according to bodyweight and dose: analysis of individual patient data from randomised trials. Lancet 2018; 392: 387-399
- 25 Abdelaziz H, Saad M, Pothineni N. et al. Aspirin for primary prevention of cardiovascular events. J Am Coll Cardiol 2019; 73: 2915-2929
- 26 Gachet C. P2 receptors, platelet function and pharmacological implications. Thromb Haemost 2008; 99: 466-472
- 27 Ittaman SV, VanWormer JJ, Rezkalla SH. The role of aspirin in the prevention of cardiovascular disease. Clin Med Res 2014; 12: 147-154
- 28 Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Lancet 1988; 2: 349-360
- 29 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
- 30 Catalano M, Born G, Peto R. Prevention of serious vascular events by aspirin amongst patients with peripheral arterial disease: randomized, double-blind trial. J Intern Med 2007; 261: 276-284
- 31 Aboyans V, Ricco JB, Bartelink MEL. et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J 2017; 39: 763-816
- 32 CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet 1996; 348: 1329-1339
- 33 Schunkert H, Boening A, von Scheidt M. et al. Randomized trial of ticagrelor vs. aspirin in patients after coronary artery bypass grafting: the TiCAB trial. Eur Heart J 2019; 40: 2432-2440
- 34 Mehta SR, Yusuf S, Peters RJ. et al. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet 2001; 358: 527-533
- 35 Chen ZM, Jiang LX, Chen YP. et al. Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet 2005; 366: 1607-1621
- 36 Bhatt DL, Fox KA, Hacke W. et al. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med 2006; 354: 1706-1717
- 37 Bhatt DL, Flather MD, Hacke W. et al. Patients with prior myocardial infarction, stroke, or symptomatic peripheral arterial disease in the CHARISMA trial. J Am Coll Cardiol 2007; 49: 1982-1988
- 38 Bonaca MP, Bhatt DL, Cohen M. et al. Long-Term Use of Ticagrelor in Patients with Prior Myocardial Infarction. N Engl J Med 2015; 372: 1791-1800
- 39 Vranckx P, Valgimigli M, Jüni P. et al. Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months vs. aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug-eluting stent: a multicentre, open-label, randomised superiority trial. Lancet 2018; 392: 940-949
- 40 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
- 41 Anand SS, Bosch J, Eikelboom JW. et al. Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial. Lancet 2018; 391: 219-229
- 42 Piepoli MF, Hoes AW, Agewall S. et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016; 37: 2315-2381
- 43 Vandvik PO, Lincoff AM, Gore JM. et al. Primary and secondary prevention of cardiovascular disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (Suppl. 02) e637S-e668S
- 44 American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes–2019. Diabetes Care 2019; 42 (Suppl. 01) S13-S28
- 45 Arnett DK, Blumenthal RS, Albert MA. et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019; 140: e596-e646