Acetylsalicylsäure und bioptische Verfahren in der Pneumologie

Einleitung

Acetylsalicylsäure (ASS) wird heute mit zunehmender Häufigkeit eingesetzt, um Rezidive nach zerebralen Insulten oder Myokardinfarkten zu verhindern, nach kardiovaskulären Eingriffen, bei Vorhofflimmern oder bei peripherarterieller Verschlusskrankheit. In der Behandlung degenerativer und entzündlicher Erkrankungen des Bewegungsapparates spielt ASS heute nur noch eine geringe Rolle; hier wurde es von den nichtsteroidalen Antiphlogistika wie Ibuprofen, Diclophenac oder den neueren COX-2-Inhibitoren abgelöst. Entsprechend nimmt eine zunehmende Zahl pneumologischer Patienten ASS ein. Die Vorgehensweise vor pneumologischen Probenentnahmen bei Patienten, die ASS einnehmen, ist unterschiedlich, es gibt keine Richtlinien. In Analogie zu chirurgischen Studien wird meist ASS 3 - 7 Tage vor der Biopsie abgesetzt. Dies geschieht in erster Linie aus forensischen Gründen. Es gibt keine Untersuchungen, die das Blutungsrisiko bioptischer Verfahren in der Pneumologie für Patienten unter ASS prüften. Deshalb wird die Bedeutung von ASS bei bioptischen Verfahren in der Pneumologie analog aus anderen invasiven Bereichen hergeleitet.

Niedrigdosiert ASS (= < 300 mg/d) wird in den USA regelmäßig von 9 % nicht akut kranker Menschen über dem 60. Lebensjahr eingenommmen. In Großbritannien sind es 8 % der Krankenhauspatienten und 6 % eines vergleichbaren Kollektives [1]. ASS ist zudem in einer großen Anzahl rezeptfreier Schmerzmittel enthalten.

Das Risiko einer erhöhten perioperativen Blutungsgefahr unter ASS wird immer wieder von verschiedenen chirurgischen Fachbereichen untersucht und diskutiert. Die invasive pneumologische Diagnostik ist in der Regel semielektiv und gestattet, 3 - 7 Tage nach Absetzen von ASS, eine Erholung der Thrombozytenfunktion abzuwarten. Dies ist frühzeitig zu koordinieren bei immer kürzer werdenden Liegezeiten in den Kliniken. Diese Übersichtsarbeit soll eine Orientierung für die Planung invasiver Diagnostik bei pneumologischen Patienten unter ASS zur Hand geben.

Der Pneumologe und Internist soll die Indikationen, die Kontraindikationen und die Pharmakologie der ASS-Therapie kennen und kompetent entscheiden können, ob ASS pausiert oder abgesetzt werden kann.

Literatur

• 1 Weil J, Colin-Jones D, Langman M, Lawson D, Logan R, Murphy M, Rawlins M, Vessey M, Wainwright P. Prophylactic aspirin and the risk of peptic ulcer bleeding.  BMJ. 1995;  310 827-830
• 2 Antiplatelet Trialists Collaboration . Collaborative overview of randomised trials of antiplatelet therapy.  BMJ. 1994;  308 81-106
• 3 Juul-Moller S, Edvardsson N, Jahnmatz B, Rosen A, Sorenson S, Omblus R. Doubleblind trial of aspirin in primary prevention of myokardial infarction in patients with stable chronic angina pectoris.  Lancet. 1992;  340 1421-1425
• 4 The Dutch TIA Trial Study Group . A comparison of two doses of aspirin (30 mg vs 283 mg a day) in 3131 patients after a transient ischemic attack or minor ischemic stroke.  N Engl J Med. 1991;  325 1261-1266
• 5 Albers G W. Atrial fibrillation and stroke: three new studies, three remaining questions.  Arch Intern Med. 1994;  154 1443-1448
• 6 Burkhard-Meier C, Deutsch J, Erdmann E. Antikoagulation beim Vorhofflimmern.  DMW. 2000;  125 1267-1271
• 7 Laupacis A, Albers G, Dalen J, Dun M I, Jacobson A K, Singer D E. Antithrombotic therapy in atrial fibrillation.  Chest. 1998;  114 (Suppl 5) 579S-589S
• 8 Altman R, Rouvier J, Curfinkel E, Scazziota A, Turpie A G. Comparison of two levels of anticoagulant therapy in patients with substitute heart valves.  J Thorac Cardiovasc Surg. 1991;  101 427-431
• 9 ISIS-2 (Second international study of infarct survival) collaborative group . Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17 187 cases of suspected acute myocardial infarction: ISIS-2.  Lancet. 1988;  2 349-360
• 10 Oler A, Whooley M A, Oler J, Grady D. Adding heparin to aspirin reduces the incidence of mycardial infarction and death in patients with unstable angina: a metaanalysis.  JAMA. 1996;  272 811-815
• 11 Lembo N J, Black A J, Roubin G S, Wilentz J R, Mufson L H, Douglas JS j r, King S B. Effect of pretreatment with aspirin versus aspirin plus dipyridamole on frequency and type of acute complications of percutaneous transluminal coronary angioplasty.  Am J Cardiol. 1990;  65 422-426
• 12 Baim D S, Carrozza J P. Stent thrombosis: closing in on the best preventive treatment.  Circulation. 1997;  95 1098-1100
• 13 Goldman S, Copeland J, Moritz T, Henderson W, Zadina K, Ovitt T, Doherty J, Read R. Improvement in early saphenous vein graft patency after coronary artery bypass surgery with antiplatelet therapy.  Circulation. 1988;  77 1324-1332
• 14 Goldman S, Copeland J, Moritz T, Henderson W, Zadina K, Ovitt T, Kern K B, Sethi G. Starting aspirin therapy after operation: effects on early graft patency. Departement of veterans affaire cooperative study group.  Circulation. 1991;  84 520-526
• 15 Goldman S, Copeland J, Moritz T, Henderson W, Zadina K, Ovitt T, Kern K B, Sethi G, Sharma G V, Khuri S. Long-term graft patency (3 years) after coronary artery surgery: effects of aspirin: results of a VA cooperative study.  Circulation. 1994;  89 1138-1143
• 16 Steering Comittee of the Physicians¿ Health Study Research G roup. Final report on the aspirin component of the ongoing physicians' health study.  N Engl J Med. 1989;  321 129-135
• 17 Manson J E, Stampfer M J, Colditz G A, Willet W C, Rosner B, Speizer F E, Hennekens C A. A prospective study of aspirin use and primary prevention of cardiovascular disease in women.  JAMA. 1991;  266 521-527
• 18 He J, Whelton P K, Vu B, Klag M J. Aspirin and the risk of hemorrhagic stroke: a metaanalysis of randomized controlled trials.  JAMA. 1998;  280 1930-1935
• 19 International Stroke Trial Collaborative Group . The international stroke trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19 435 patients with acute ischemaemic stroke.  Lancet. 1997;  349 1569-1581
• 20 Chinese Acute Stroke Trial Collaborative Group . CAST: randomised placebo-controlled trial of early aspirin use in 20 000 patients with acute ischaemic stroke.  Lancet. 1997;  349 1641-1649
• 21 Tijssen J PG. Low-dose vs high-dose acetylsalicylic acid, with and without dipyridamole: a review of clinical trial results.  Neurology. 1998;  51 (suppl 3) S15-S16
• 22 Cote R, Battista R N, Abrahamowicz M, Langlois Y, Bourque F, Mackey A. and the asymptomatic cervical bruit study group . Lack of effect of aspirin in asymptomatic patients with carotid bruits and substantial carotid narrowing.  Ann Intern Med. 1995;  123 649-655
• 23 Awtry E H, Loscalzo J. Aspirin.  Circulation. 2000;  101 1206-1218
• 24 Report of the American College of Cardiology/American Heart Association Task Force on practice guidelines . Guidelines for perioperative cardiovascular evaluation for noncardiac surgery.  J Am Coll Cardiol. 1996;  27 910-948; Circulation. 1996;  93 1278-1317
• 25 Fitzgerald G A. Mechanisms of platelet activation.  Am J Cardiol. 1991;  68 11B-15B
• 26 Hoogendijk E MG, TenCate J W. Aspirin and platelets.  Lancet. 1980;  1 93-94
• 27 Jaffe E A, Weksler B B. Recovery of endothelial cell prostacyclin production after inhibition by low doses of aspirin.  J Clin Invest. 1979;  63 532-535
• 28 Walter E. Thrombocytenaggregationshemmung durch Acetylsalicylsäure. Stuttgart, New York: Fischer 1985
• 29 Patrona C, Collar B, Dalen J, Fuster V, Gent M, Harker L, Hirsh J, Roth G. Platelet-active drugs: the relationships among dose, effectiveness, and side effects.  Chest. 1998;  114 470S-488S
• 30 Hirsh J, Dalen J E, Fuster V, Harker L B, Patrono C, Roth G. Aspirin and other platelet-active drugs.  Chest. 1995;  108 S247-S257
• 31 Patrona C, Ciabattoni G, Patrignani P, Pugliese F, Fillabozzi P, Catella F, Davi G, Forni L. Clinical pharmacology of platelet cycloocygenase inhibition.  Circulation. 1985;  72 177-184
• 32 Mielke C H. Aspirin prolongation of the template bleeding time.  Blood. 1982;  60 1139-1142
• 33 Roderick P J, Wilkes H C, Meade T W. The gastrointestinal toxicity of aspirin: an overview of randomised controlled trials.  Br J Clin Pharmacol. 1993;  35 219-226
• 34 Nawarskas J J, Spinler S A. Does aspirin interfere with the therapeutic efficacy of angiotensin-converting enzyme inhibitors in hypertension or congestive heart failure?.  Pharmacotherapy. 1998;  18 1041-1052
• 35 Sandler D P, Burr F R, Weinberg C R. Nonsteroidal anti-inflammatory drugs and the risk for chronic renal disease.  Ann Intern Med. 1991;  115 165-172
• 36 Lee T H. Mechanism of aspirin sensitivity.  Am Rev Respir Dis. 1992;  145 S34-S36
• 37 Benzon H T, Brunner E A, Vaisrub N. Bleeding time and nerve blocks after aspirin.  Reg Anesth. 1984;  9 86-89
• 38 Horlocker T T, Wedel D J, Offord K P. Does preoperative antiplatelet therapy increase the risk of hemorrhagic complications associated with regional anesthesia.  Anesth Analg. 1990;  70 631-634
• 39 Ruff R L, Dougherty J H. Complications of lumbar puncture followed by anticoagulation.  Stroke. 1981;  12 879-881
• 40 Ala-Opas M Y, Grönlund S S. Blood loss in long-term aspirin users undergoing transurethral prostatectomy.  Scand J Urol Nephrol. 1996;  30 (3) 203-206
• 41 Sauer W, Schwagmeier R, Nolte H. Dauermedikation mit Acetylsalicylsäure - ein Problem für die Regionalanästhesie.  Anaesthesist. 1992;  41 489-493
• 42 An H S, Mikhail W E, Jackson W T, Tolin B, Dodd G A. Effects of hypotensive anesthesia, nonsteroidal antiinflammatory drugs, and polymethylmethacrylate on bleeding in total hip arthroplasty patients.  J Arthroplasty. 1991;  6 (3) 245-250
• 43 Harris W H, Salzman E W, Athanasoulis C, Waltman A C, Baum S, DeSanctis R W. Comparison of warfarin, dextran, aspirin and subcutaneous heparin in prevention of venous thrombembolism following total hip replacement.  N Engl J Med. 1977;  297 1246-1949
• 44 Powers P J, Gent M, Jay R M, Julian D H, Turpie A G, Levine M, Hirsh J. A randomized trial of less intense postoperative warfarin or aspirin therapy in the prevention of venous thromboembolism after surgery for fractured hip.  Arch Intern Med. 1989;  149 771-774
• 45 Hull R, Delmore T J, Hirsh J, Gent M, Armstrong P, Lofthouse R, MacMillan A, Blackstone J, Reed-Davis R, Detwiler R C. Effectiveness of intermittend pulsatile elastic stockings for the prevention of calf and thigh vein thrombosis in patients undergoing elective knee surgery.  Thromb Res. 1979;  16 37-45
• 46 Pulmonary Embolism Prevention (PEP) Trial . Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin.  Lancet. 2000;  15; 355 1295-1302
• 47 Collaborative overview of randomised trials of antiplatelet therapy - III . Reduction in venous thrombosis and pulmonary embolism by antiplatelet prophylaxis among surgical and medical patients.  BMJ. 1994;  308 235-246
• 48 Bashein G, Neely M L, Rice A L, Counts R B, Misbach G A. Preoperative aspirin therapy and reoperation for bleeding after coronary artery bypass surgery.  Arch Intern Med. 1991;  151 (1) 89-93
• 49 Torosian M, Michelson E L, Morganroth J ,. et al . Aspirin- and Coumadin-related bleeding after coronary artery bypass graft surgery.  Ann Intern Med. 1978;  89 325-328
• 50 Sethi G K, Copeland J G, Goldman S, Mortiz T, Zadina K, Henderson W G. Implications of preoperative administration of aspirin in patients undergoing coronary artery bypass grafting.  J Am Coll Cardiol. 1990;  15 15-20
• 51 Ferraris V A, Ferraris S P, Lough F C, Berry W R. Preoperative aspirin ingestion increases operative blood loss after coronary artery bypass grafting.  Ann Thorac Surg. 1988;  45 71-74
• 52 Ferraris V A, Gildengorin V. Predictors of excessive blood use after coronary bypass grafting.  J Thorac Cardiovasc Surg. 1989;  98 492-497
• 53 Taggart D P, Siddiqui A, Wheatley D J. Low-dose preoperative aspirin therapy, postoperative blood loss, and transfusion requirements.  Ann Thorac Surg. 1990;  50 425-428
• 54 Rawitscher R E, Jones J W, McCoy T A, Lindsley D A. A prospective study of aspirin's effect on red blood cell loss in cardiac surgery.  J Cardiovasc Surg. 1991;  32 (1) 1-7
• 55 Vuylsteke A, Oduro A, Cardan E, Latimer R D. Effects of aspirin in coronary artery bypass grafting.  J Cardiothorac Vasc Anesth. 1997;  11 (7) 831-834
• 56 Bartlett G R. Does aspirin affect the outcome of minor cutaneous surgery?.  Br J Plast Surg. 1999;  52 214-216
• 57 Billingsley E M, Maloney M E. Intraoperative and postoperative bleeding problems in patients taking warfarin, aspirin, and NSAID: a prospective study.  Dermatol Surg. 1997;  23 381-385
• 58 Lawrence C, Sakuntabhai A, Tiling-Grosse S. Effect of aspirin and nonsteroidal antiinflammatory drug therapy on bleeding complications in dermatologic surgical patients.  J Am Acad Dermatol. 1994;  31 988-992
• 59 Assia E I, Raskin T, Kaiserman I, Rotenstreich Y, Degev F. Effects of aspirin intake on bleeding during cataract surgery.  J Cataract Refract Surg. 1998;  24 1243-1246
• 60 Kokolakis S, Zafirakis P, Livis-Rollatos G, Ladas I, Damanakis A. Aspirin intake and bleeding during cataract surgery.  J Cataract Refract Surg. 1999;  25 301-302
• 61 Gavriliuk A I. Fibrinolytic haemorrhages in patients with prostatic adenoma treated with acetyl salicylate in the perioperative period.  Vrach-delo. 1987;  1 96-98
• 62 Mongin D, Ville D, Sagnard P ,. et al . Prevention of venous thrombosis following prostatic transurethral resection (TUR): A comparative study of acetyl-salicylic acid and calcium heparinate.  Agressologie. 1983;  24 523-525
• 63 Watson C JE, Deane A M, Doyle P T, Bullock K N. Identifiable factors in post-prostatectomy hemorrhage: the role of aspirin.  Br J Urol. 1990;  66 85-87
• 64 Kretschmer V. Perioperatives Blutungsrisiko bei Einnahme von ASS bei urologischen Operationen.  Der Urologe A. 1998;  37 (6) 675-676
• 65 Ardekian L, Gaspar R, Peled M, Brener B, Lauder D. Does low-dose aspirin therapy complicate oral surgical procedures.  JAMA. 2000;  131 331-335
• 66 Lethagen S. Desmopressin - a haemostatic drug: state of the art review.  Eur J Anaesthesiol Suppl. 1997;  14 S1-S9
• 67 Beck K H, Bleckmann U, Mohr P, Kretschmer V, Huss B. Shortening of acetylsalicylic acid-prolonged bleeding time by means of desmopressin.  Beitr Infusionsther Transfusionsmed. 1994;  32 437-439
• 68 Diette G B, Wiener C M, White P. The higher risk of bleeding in lung transplant recipients from bronchoscopy is independent of traditional bleeding risks.  Chest. 1999;  115 397-402
• 69 Bjortuft O, Brosstad F, Boe J. Bronchoscopy with transbronchial biopsies: measurement of bleeding volume and evaluation of the predictive value of coagulation tests.  Eur Resp J. 1998;  12 1025-1027
• 70 Blasco L H, Hernandez I MS, Garrido V V, Poch E M, Delgado M N, A J A. Safety of the transbronchial biopsy in outpatients.  Chest. 1991;  99 562-565
• 71 Pereira W, Kownat D M, Snider G L. A prospective cooperative study of complications following flexible fiberoptic bronchoscopy.  Chest. 1978;  73 813-816
• 72 Ahmad M, Livingstone D R, Golih J A, Mehta A C, Wiedemann H P. The safety of outpatient transbronchial biopsy.  Chest. 1986;  90 403-405
• 73 Simpson F G, Arnold A G, Purvis A, Belfield P W, Muers M F, Cooke N J. Postal survey of bronchoscopic practice by physicians in the UK.  Thorax. 1986;  41 311-317
• 74 Hanson R R, Zavala D C, Rhodes M L, Keim L W, Smith J D. Transbronchial biopsy via flexible fiberoptic bronchoscope: results in 164 patients.  Am Rev Respir Dis. 1976;  114 67-72
• 75 Levin D C, Wicks A B, Ellis J H. Transbronchial biopsy via flexible fiberoptic bronchoscope.  Am Rev Respir Dis. 1974;  110 4-12
• 76 Ellis J H. Transbronchial lung biopsy via flexible fiberoptic bronchoscope: experience with 107 consecutive cases and comparison with transbronchial brushing.  Chest. 1975;  68 524-532
• 77 Zavala D C. Diagnostic fiberoptic bronchoscopy: technics and results of biopsy in 600 patients.  Chest. 1975;  68 12-19
• 78 Koerner S K, Sakowitz A J, Appelmann R I, Becker N H, Schoenbaum S W. Transbronchial biopsy for the diagnosis in sarcoidosis.  N Engl J Med. 1975;  293 268-270
• 79 Joyner L R, Scheinhorn D J. Transbronchial forceps biopsy through the fiberoptic bronchoscope: diagnosis of diffuse pulmonary disease.  Chest. 1975;  67 532-535
• 80 Zavala D C. Pulmonary hemorrhage in fiberoptic transbronchial biopsy.  Chest. 1976;  70 584-588
• 81 Cunningham J H, Zavala D C, Corry R J, Keim L W. Trephine air drill, bronchial brush, and fiberoptic transbronchial biopsies in immunsuppressed patients.  Am Rev Respir Dis. 1977;  115 213-220
• 82 Feldman N T, Pennington J E, Ehrie M G. Transbronchial lung biopsy in the compromised host.  JAMA. 1977;  238 1377-1379
• 83 Herf S M, Suratt P M. Complications of transbronchial lung biopsies.  Chest. 1978;  73 759-760
• 84 Anderson H A. Transbronchial lung biopsy for the diffuse pulmonary diseases results in 939 patients.  Chest. 1978;  73 734-736
• 85 Stableforth D E, Knight R H, Collins J V, Heard B E, Clarke S W. Transbronchial lung biopsy through the fiberoptic bronchoscope.  Br J Dis Chest. 1978;  72 108-114
• 86 Poe R H, Utell M J, Israel R H, Hall W J, Eshleman J D. Sensitivity and specifity of the nonspecific transbronchial lung biopsy.  Am Rev Respir Dis. 1979;  119 25-31
• 87 Wall C P, Gaensler E A, Carrington C B, Hayes J A. Comparison of transbronchial and open biopsies in chronic infiltrative lung diseases.  Am Rev Respir Dis. 1981;  123 280-285
• 88 Mitchell D M, Emerson C J, Collins J V, Stableforth D E. Transbronchial lung biopsy with the fiberoptic bronchoscope: analysis and results in 433 patients.  Br J Dis Chest. 1981;  75 258-262
• 89 Pue C A, Pacht E R. Complications of fiberoptic bronchoscopy at a university hospital.  Chest. 1995;  107 430-432
• 90 Kozak E A, Brath L K. Do screening coagulation tests predict bleeding in patients undergoing fiberoptic bronchoscopy with biopsy.  Chest. 1994;  106 703-705
• 91 Fulkerson W J. Current concepts: fiberoptic bronchoscopy.  N Engl J Med. 1984;  311 511-515
• 92 Shure D. Transbronchial biopsy and needle aspiration.  Chest. 1989;  95 1130-1138
• 93 De Caterina R, Lanza M, Manca G, Buti Strata G, Maffei S, Salvatore L. Bleeding time and bleeding: an analysis of the relationsship of the bleeding time test with parameters of surgical bleeding.  Blood. 1994;  84 (10) 3363-3370
• 94 Mielke C H, Kaneshiro M M, Maher I A. The standardised normal Ivy Bleeding Time and its prolongation by aspirin.  Blood. 1969;  34 204-215
• 95 Marx R. Die Thrombozytenfunktion und ihre Bedeutung für den Hämostasemechanismus.  Therapiewoche. 1968;  18 2193
• 96 Janzarik H, Remy S, Morell S, Pabst W. „Haemostasis time”, a modified bleeding time test and ist comparison with the Duke and the Ivy/Template bleeding time.  Blut. 1986;  52 345-356
• 97 Goldsmith S M, Leshin B, Owen J. Management of patients taking anticoagulants and platelet inhibitors prior to dermatologic surgery.  J Dermatol Surg Oncol. 1993;  19 578-581
• 98 Lind S E. The bleeding time does not predict surgical bleeding.  Blood. 1991;  77 2547-2552
• 99 Williams H D, Howard R, O'Donnell N, Findley I. The effect of low dose aspirin on bleeding times.  Anaesthesia. 1993;  48 331-333
• 100 Frith P A, Warlow C P. A study of bleeding time in 120 long-term aspirin trial patients.  Thrombosis Research. 1988;  49 463-470
• 101 Amrein P C, Ellman L, Harris W H. Aspirin induced prolongation of bleeding time and perioperative blood loss.  JAMA. 1981;  245 1825-1828
• 102 Ferraris V A, Swanson E. Aspirin usage and perioperative blood loss in patients undergoing unexpected operations.  Surg Gyn Obstet. 1983;  156 439-442
• 103 Ramsey G, Arvan D A, Stewart S, Blumberg N. Do preoperative laboratory tests predict blood transfusion needs in cardiac operation.  J Thorac Cardiovasc Surg. 1983;  85 564-569
• 104 Gewirtz A S, Miller M L, Keys T F. The clinical usefulness of the preoperative bleeding time.  Arch Pathol Lab Med. 1996;  120 (4) 353-356
• 105 Bartley G B, Warndahl R A. Surgical bleeding associated with aspirin and nonsteroidal anti-inflammatory agents.  Mayo Clin Proc. 1992;  67 402-403
• 106 Schmidt B MW, Mehling M. Der Einsatz von Thrombozytenaggregationshemmern in der Kardiologie.  Internist. 1997;  38 1242-1246
• 107 Caplain H, Cariou R. Long-term activity of clopidogrel: a three-month appraisal in healthy volunteers.  Semin Thromb Hemost. 1999;  25 Suppl 2 21-24
• 108 Stuart M J, Miller M L, Davey F R, Wolk J A. The post-aspirin bleeding time: a screening test for evaluating haemostatic disorders.  Br J Haematol. 1979;  43 649-659