Antithrombozytäre Therapie und Antikoagulation bei Patienten mit koronarer Herzerkrankung

Die koronare Herzkrankheit (KHK) ist ein dynamischer Prozess mit akuten instabilen Ereignissen und chronischen Perioden, die zu einer erhöhten Mortalität führen. Patienten mit KHK profitieren von einer differenzierten antithrombotischen Therapie. Dieser Artikel bietet Informationen zu den verschiedenen Medikamenten und therapeutischen Algorithmen basierend auf den neuesten ESC-Richtlinien und aktuellen Studien.

Abstract

Coronary heart disease (CHD) is a dynamic process with acute instable events and chronic periods leading to an increased mortality. Patients with CHD benefit from a differentiated antithrombotic therapy consisting of dual antiplatelet therapy in the acute phase and antiplatelet monotherapy or in combination with low dose anticoagulation (Xa-Inhibition) in the chronic phase. Current ESC-guidelines differentiate the acute coronary syndrome (ACS) and the chronic coronary syndrome (CCS). Depending on thrombotic burden, bleeding risk, comorbidities, such as atrial fibrillation, antiplatelet agents and oral anticoagulants in various combinations and dosages are used. In most scenarios in patients with ACS, the initial therapy will consist out of acetylsalicylic acid and a P2Y₁₂-Inhibitor for 12 months followed by either a continuous monotherapy with acetylsalicylic acid (ASS), a prolonged dual antiplatelet therapy or a continuous dual antithrombotic therapy consisting of ASS and low dose rivaroxaban 2x daily. With atrial fibrillation as an underlying condition, an anticoagulant should be part of the therapy followed by anticoagulant monotherapy in the chronic phase of the disease (CCS). This article provides information about the different drugs and therapeutic algorithms based on the newest ESC-Guidelines and up to date studies.

Schlüsselwörter

NSTEMI - antithrombotische Therapie - Antikoagulation - koronare Herzkrankheit - duale Plättchenaggregationshemmung - duale antithrombotische Therapie - chronisches Koronarsyndrom

Key words

non-ST-Elevation myocardial infarction - antithrombotic therapy - anticoagulation - coronary heart disease - dual platelet inhibition - dual antithrombotic therapy - chronic coronary syndrome

Publication History

Article published online:
20 August 2021

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