Antithrombotische Therapie bei Nicht-ST-Hebungsinfarkt

Zusammenfassung

Der Myokardinfarkt ohne ST-Streckenhebung zählt zu den akut lebensbedrohlichen Manifestationen der koronaren Herzerkrankung. Eine kombinierte plättchenhemmende und antithrombotische Therapie (bestehend aus Azetylsalizylsäure, Clopidogrel, Heparin, und Glykoprotein-IIb/IIIa- Inhibititoren) zusammen mit einem früh-invasiven Vorgehen (d. h. Koronarangiographie und Stentimplantation innerhalb von 24-48 Stunden) verbessern das Ergebnis von Patienten mit akutem Nicht-ST-Hebungsinfarkt in der Primärversorgung. Durch eine duale Plättchenhemmung mit Clopidogrel und Azetylsalizylsäure wird das Risiko eines ischämischen Rezidivereignisses auch im Langzeitverlauf gesenkt. Eine antithrombotische Strategie wird in Zukunft idealerweise fatale Ereignisse vor einer Revaskularisation reduzieren und die Ergebnisse der perkutanen Koronarintervention verbessern können ohne gleichzeitig das Blutungsrisiko zu erhöhen.

Summary

Non-ST segment elevation myocardial infarction (NSTEMI) is an acute life-threatening event which has a high rate of recurrence. Combined antithrombotic therapy (including acetylsalicylic acid, clopidogrel, heparins and glycoprotein IIb/IIIa receptor antagonists) substantially reduced major coronary events during the acute phase of coronary heart disease with a good tolerance because of the short duration of such aggressive strategy. The combined antithrombotic strategy also allows to increase the benefit of an early invasive strategy including coronary angiogram with stent percutaneous coronary angioplasty which recent trials have shown that to be preferable to a conservative approach in these high risk patients. Antithrombotic and antiplatelet therapy in association with coronary revascularization play an important role in the prevention of an adverse outcome. Recently, clopidogrel has been shown reduce recurrent ischaemic events, both early and during the first year after non-ST-segment elevation myocardial infarction. An ideal antithrombotic and antiplatelet strategy will reduce events before revascularization, enhance the revascularization procedure without excessive bleeding.

Schlüsselwörter

Akutes Koronarsyndrom - antithrombotische Therapie

Keywords

Acute coronary syndrome - antithrombotic therapy

• References

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