Klinische Bedeutung von Thrombozytenfunktionshemmern

Zusammenfassung

Der älteste Thrombozytenfunktionshemmer, die Azetylsalizylsäure (ASS), wird auch heute noch weltweit zur Verhütung thrombotischer arterieller Gefäßverschlüsse eingesetzt. Die Hauptindikation ist die Prävention von Reinfarkten nach überstandenem Herzinfarkt. Die heute übliche ASS-Dosierung beträgt 100–300 mg/Tag. Ticlopidin und seine Nachfolgesubstanz Clopidogrel sind etwas wirksamer als ASS. Die Kombination von ASS mit Ticlopidin oder Clopidogrel hat besonders in der Verhütung von Reverschlüssen nach koronaren Interventionen Bedeutung erlangt. Die neuesten Thrombozytenfunktionshemmer, die Hemmer der Plättchenmembran-Glykoproteine IIb/IIIa, waren bei intravenöser Gabe in der Kombination mit ASS und Heparin zur Verhütung von koronaren Gefäßverschlüssen bei akuten koronaren Syndromen, besonders nach Stentimplantationen und bei Risikoangioplastien, wirksam. Orale GPIIb/IIIa-Hemmer waren dagegen in drei großen klinischen Studien unwirksam. Auch hier sind aber von langzeitwirkenden Medikamenten und von einer besseren Therapieüberwachung weitere Fortschritte zu erwarten.

Summary

The oldest platelet function inhibitor acetylsalicylic acid (ASA or aspirin) is today used worldwide for the prevention of thrombotic arterial vascular occlusions. The main indication is the prevention of reinfarction after acute myocardial infarct. The daily dose of ASA today usually is 100–300 mg. Ticlopidine and its successor clopidogrel are slightly more effective than ASA. The combination of ASA with ticlopidine or clopidogrel has been effective in the prevention of reocclusions after coronary interventions. The newest platelet function inhibitors, the inhibitors of platelet membrane glycoproteins IIb/IIIa, have been very effective when combined with ASA and heparin in the prevention of coronary reocclusions, especially in acute coronary syndromes, after stent implantations and in high risk angioplasty. Oral GP IIb/IIIa-inhibitors were not effective in three large clinical trials. Progress can be expected from longtime acting drugs and from an im-proved monitoring of the treatment with new agents.

Schlüsselwörter

Azetylsalizylsäure - Ticlopidin - Clopidogrel - Glykoprotein-IIb/IIIa-Rezeptor-Hemmer - Thromboseprophylaxe

Keywords

Acetylsalicylic acid - ticlopidine - clopidogrel - glycoprotein IIb/IIIa receptor antagonists - thrombosis prophylaxis

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