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Hamostaseologie 2001; 21(03): 125-129
DOI: 10.1055/s-0037-1619511
Original article
Schattauer GmbH

Niedermolekulare Heparine in der Kardiologie

In der Therapie der instabilen Angina pectoris heute schon »state-of-the-art«[*] Low-molecular-weight heparins in cardiology
W. Lankes
1   Charité – Humboldt-Universität zu Berlin, Franz-Volhard-Klinik
,
D. C. Gulba
2   Krankenhaus Düren gGmbH, Medizinische Klinik I mit Schwerpunkt Kardiologie, Angiologie und Pulmonologie
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Publication History

Publication Date:
27 December 2017 (online)

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Zusammenfassung

Bei thromboembolischen Herzerkrankungen hat sich unfraktioniertes Heparin in hohen Dosen als außerordentlich wirksam erwiesen. Bei der subkutanen Verabreichung muss jedoch mit einer unsicheren Resorption aus dem subkutanen Fettgewebe gerechnet werden, weshalb im Allgemeinen eine intravenöse Heparin-Dauerinfusion bevorzugt wird. Das ungünstige pharmakologische Profil der Substanz und die hohen inter- und intraindividuellen Schwankungen der Dosis-Wirkungs-Beziehung ziehen jedoch bei intravenöser Verabreichung die Notwendigkeit engmaschiger Laborkontrollen nach sich (Übersicht bei [1, 2]).

Die Frühmobilisation und die Erhaltung der Mobilität kardial erkrankter Patienten nehmen heute in der Therapie einen dominanten Platz ein. Die Notwendigkeit der intravenösen Verabreichung ebenso wie die Komplexität der Therapie stehen bei den unfraktionierten Heparinen der Frühmobilisation und der ambulanten Fortführung der Behandlung entscheidend entgegen. Mit den fraktionierten (niedermolekularen) Heparinen steht nunmehr eine Heparinklasse zur Verfügung, die neben der verlässlichen Resorption aus dem subkutanen Fettgewebe auch eine wesentlich besser vorhersagbare Dosis-Wirkungs-Beziehung aufweist (Übersicht bei [1, 2]). Da diese Heparine darüber hinaus bei der primären Anwendung sehr viel seltener mit der Ausbildung einer lebensgefährlichen HIT (Heparin-induzierte Thrombozytopenie) assoziiert sind (3), wird ihr routinemäßiger Einsatz auch bei kardiologisch erkrankten Patienten immer häufiger erwogen. Das instabile Koronarsyndrom (instabile Angina pectoris und nicht-transmuraler Herzinfarkt) nimmt diesbezüglich eine Vorreiterrolle in der Kardiologie ein.

Summary

Full-dose unfractionated heparin has proved to be extraordinarily effective in thromboembolic heart diseases. However, unreliable absorption in the subcutaneous fatty tissue after subcutaneous administration must be expected, so continuous intravenous infusions are generally preferred. Nevertheless, the unfavourable pharmacological profile of the substance, and the broad inter- and intraindividual fluctuations of the dose/effect relationship following intravenous administration require close biochemical monitoring (Summary see [1, 2]). Early ambulation and retaining mobility for heart patients play a dominant role in current therapy. The need for intravenous administration and the complexity of therapy are convincing opposing factors against early mobilisation and continuing outpatient treatment with unfractionated heparin. The fractionated (low molecular weight) heparins provide a class of heparins which are not only reliably absorbed in the subcutaneous fatty tissue, but also have a more predictable dose/effect relationship (Summary see [1, 2]). Furthermore, since the primary use of these heparins is associated far less commonly with the development of life-threatening HIT (heparin-induced thrombocytopenia) (3), their routine use is considered increasingly often, even for patients with heart disease. In this context, the unstable coronary syndrome (unstable angina pectoris and nontransmural myocardial infarction) is assuming a pioneering role in cardiology.

Schlüsselwörter

Akutes Koronarsyndrom - instabile Angina - niedermolekulare Heparine

Keywords

Acute coronary syndrome - unstable angina pectoris - LMWH

* Herrn Prof. Dieter L. Heene zum 65. Geburtstag


 

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