Antikoagulanzien oder Aggregationshemmer

Zusammenfassung

Die thrombolytische Therapie ist das Mittel der Wahl zur Behandlung des akuten Myokardinfarktes. Mit welchen Medikamenten lassen sich aber die nach einem Herzinfarkt erfolgreich wiedereröffneten Koronargefäße offen halten und spätere Reinfarkte verhindern? In einer großen prospektiven Studie konnte der positive Effekt von ASS in Kombination mit thrombolytischer Therapie auf die frühe Mortalität nach Herzinfarkt gezeigt werden. Weiterführende Studien erbrachten, daß eine Kombination von ASS und Heparin, letzteres 24 Stunden bis zu 7 Tage nach Infarkt und thrombolytischer Therapie, ein bestmöglicher Schutz vor einem Reverschluß darstellt. In der Sekundärprävention nach Myokardinfarkt ist ASS in Dosen von 160-300 mg/d als Langzeitprophylaxe wirksam, wie verschiedene Studienergebnisse zeigen. Orale Antikoagulanzien werden vor allem bei Patienten mit Herzwandthrombus eingesetzt. Nach PTCA verhindert ASS den akuten Reverschluß. Längerfristig läßt sich die Restenosierung des dilatierten Gefäßes jedoch nicht verhindern.

Schlüsselwörter

Myokardinfarkt - Thrombolyse - ASS - Heparin

Keywords

Myocardial infarction - thrombolysis - aspirin - heparin

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