Hemmung der Thrombozytenaggregation mit Prasugrel

Zusammenfassung

Nicht nur bei der Entstehung der koronaren Herzerkrankung (KHK), sondern insbesondere beim akuten Koronarsyndrom (ACS) spielen Thrombozyten eine zentrale Rolle. Der zugrundeliegenden Plaqueruptur beim ACS folgt eine durch Thrombozyten getriggerte überschießende Reaktion des Organismus mit dem Ziel, die entstandene „Wunde” zu verschließen. Für die Therapie gilt deshalb, die Aktivität der Thrombozyten zu reduzieren. Etabliert ist dabei die Acetylsalicylsäure (ASS), die sich in der Akutsituation und in der Sekundärprophylaxe von koronaren Ereignissen bewährt hat. Im Zeitalter der perkutanen Interventionen war dies jedoch nicht ausreichend. Erst die duale Hemmung der Thrombozytenaggregation mit Thienopyridinen, wie zunächst Ticlopidin, später Clopidogrel in Kombination mit ASS, erbrachte den Durchbruch nicht nur in der Prophylaxe von Stentthrombosen, sondern verbesserte die Prognose beim ACS.

Der vorliegende Beitrag gibt eine Übersicht über die aktuellen Entwicklungen auf dem Gebiet der Thienopyridine. Der Schwerpunkt liegt in der Evidenz-basierten Nutzenbewertung von Prasugrel bzw. Prasugrel im Vergleich zu Clopidogrel in der klinischen Praxis.

Abstract

Platelet activation plays a pivotal role in the pathogenesis of coronary artery disease. The long-term benefit of dual anti-platelet therapy with clopidogrel and aspirin is well established for patients with acute coronary syndrome and for secondary prophylaxis of coronary artery disease. This review discusses latest developments in the field of the thienopyridines. Particularly, we focus on the evidence-based use of prasugrel or prasugrel versus clopidogrel in clinical practice.

Prasugrel - Clopidogrel - Thienopyridine - akutes Koronarsyndrom

prasugrel - clopidogrel - thienopyridines - acute coronary syndrome

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