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DOI: 10.1055/s-0038-1660352
Thrombolytische Therapie des akuten Herzinfarktes
Eine Metaanalyse von 300 publizierten klinischen Studien und 100000 PatientenPublikationsverlauf
Publikationsdatum:
26. Juni 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00034925/199403/lookinside/thumbnails/10-1055-s-0038-1660352-1.jpg)
Zusammenfassung
Im Rahmen der vorliegenden Metaanalyse wurden die Daten von ungefähr 100000 Patienten mit akutem Myokardinfarkt (AMI) aus 300 klinischen Thrombolysestudien ausgewertet. In einer vergleichenden Analyse wurden vor allem die Effektivität der gegenwärtig angewandten Plasminogenaktivatoren und der Einfluß einer frühen gegenüber einer späten begleitenden Heparintherapie geprüft.
Eine frühzeitige Wiedereröffnung thrombotisch verschlossener Koronarien konnte mit den neuen Plasminogenaktivatoren oder mit intrakoronarer Lyse signifikant häufiger erreicht werden als mit intravenöser Streptokinaseinfusion. Die kumulativen Krankenhaussterblichkeitsraten lagen zwischen 4% und 9%. Die Ergebnisse der Metaanalyse lassen darauf schließen, daß der frühzeitige Beginn der Antikoagulanzienbehandlung mit Heparin für die thrombolytische Therapie mit rt-PA obligatorisch ist. Der Zeitpunkt des Beginns der prophylaktischen Antikoagulation bei der Thrombolysebehandlung mit Streptokinase oder APSAC beeinflußte das Therapieergebnis nicht signifikant. Die thrombolytische Behandlung mit intravenös verabreichtem rt-PA war signifikant gegenüber allen derzeitig angewandten thrombolytischen Behandlungsstrategien überlegen, wenn eine effektive antithrombotische Therapie stattfand.
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