Kombinierte antithrombotische Therapiestrategien in der Kardiologie

Nach koronarer Stentimplantation ist die duale Plättchentherapie genauso üblich wie andererseits die Antikoagulation bei Vorhofflimmern. Weil die neuen oralen Antikoagulanzien die Vitamin-K-Antagonisten zunehmend ablösen, rückt aber eine kombinierte antithrombotische Therapie bei Indikationen in den Fokus, die bisher der Plättchentherapie vorbehalten waren.

Kernaussagen

• Die kombinierte antithrombotische Therapie aus oraler Antikoagulation und Plättchenhemmern wurde seit Etablierung der NOAKs neu untersucht. Bisher ist diese Strategie bei Patienten mit der Indikation zur Antikoagulation und gleichzeitig zur DAPT klinisch etabliert.

• Für die Sekundärprävention nach ACS ist ebenfalls eine Kombination aus DAPT und niedrigdosierter Faktor-Xa-Hemmung mit Rivaroxaban zugelassen.

• Bei Patienten in der stabilen Phase der Atherosklerose mit zusätzlichen Risikofaktoren besteht nun auch die Option der Behandlung mit einer dualen Strategie aus ASS und Rivaroxaban (2 × 2,5 mg/d). Diese erhöht zwar die Gesamtblutungsrate, senkt jedoch die Sterblichkeit.

Schlüsselwörter

antithrombotische Therapie - Vorhofflimmern - akutes Koronarsyndrom - koronare Herzerkrankung - periphere arterielle Verschlusskrankheit

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