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DOI: 10.1055/s-2007-966879
© Georg Thieme Verlag KG Stuttgart · New York
Antithrombotische Therapie nach DES
Publikationsverlauf
Publikationsdatum:
27. September 2007 (online)
![](https://www.thieme-connect.de/media/kardiologie-u2d/200703/lookinside/thumbnails/10.1055-s-2007-966879-1.jpg)
Kernaussagen
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Die Indikationsstellung zur Implantation von DES wie die Festlegung der nachfolgenden antithrombozytären Therapie erfordern eine intensive individualisierte Abwägung klinischer und angiographischer Faktoren.
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Nach koronarer Stentimplantation ist eine duale antithrombozytäre Therapie mit Acetylsalicylsäure (ASS) und Clopidogrel zur Verhinderung der Stentthrombose erforderlich. Die empfohlene Mindestdauer für BMS beträgt derzeit 1 Monat, für DES 6 - 12 Monate.
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Der Nutzen einer Intensivierung der Clopidogreldosis unter bestimmten Bedingungen (akutes Koronarsyndrom, geringes Ansprechen auf Clopidogrel) liegt nahe, muss jedoch noch abschließend bewertet werden.
Literatur
- 1 Krucoff M W, Boam A, Schultz D G. Drug-eluting stents deliver heartburn. How do we spell relief going forward?. Circulation. 2007; 115 2990-2994
- 2 Kastrati A, Schömig A. Drug-eluting stents. Is their future as bright as their past?. JACC. 2007; 50 146-148
- 3 Schomig A, Neumann F J, Kastrati A. et al . A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary-artery stents. N Engl J Med. 1996; 334 1084-1089
- 4 Leon M B, Baim D S, Popma J J. et al . A clinical trial comparing three antithrombotic-drug regimens after coronary-artery stenting. Stent Anticoagulation Restenosis Study Investigators. N Engl J Med. 1998; 339 1665-1671
- 5 Bertrand M E, Legrand V, Boland J. et al . Randomized multicenter comparison of conventional anticoagulation versus antiplatelet therapy in unplanned and elective coronary stenting. The full anticoagulation versus aspirin and ticlopidine (fantastic) study. Circulation. 1998; 98 1597-1603
- 6 Kastrati A, Mehilli J, Pache J. et al . Analysis of 14 trials comparing sirolimus-eluting stents with bare-metal stents. N Engl J Med. 2007; 356 1030-1039
- 7 Stone G W, Moses J W, Ellis S G. et al . Safety and efficacy of sirolimus- and paclitaxel-eluting coronary stents. N Engl J Med. 2007; 356 998-1008
- 8 Smith S C Jr, Feldman T E, Hirshfeld J W Jr. et al, . ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update 2001 Guidelines for Percutaneous Coronary Intervention). Circulation. 2006; 113 166-286
- 9 Pfisterer M, Brunner-LaRocca H P, Buser P T. et al. and BASKET-LATE Investigators . Late clinical events after clopidogrel discontinuation may limit the benefit of drug-eluting stents: an observational study of the drug-eluting versus bare-metal stents. J Am Coll Cardiol. 2006; 48 2584-2591
- 10 Eisenstein E L, Anstrom D J, Kong D F. et al . Clopidogrel use and long-term clinical outcomes after drug-eluting stent implantation. JAMA. 2007; 297 480-488
- 11 Moreno R, Fernandez C, Hernandez R. et al . Drug-eluting stent thrombosis results from a pooled analysis including 10 randomized studies. J Am Coll Cardiol. 2005; 45 954-959
- 12 Daemen J, Tanimoto S, Garcia-Garcia H M. et al . Comparison of three-year clinical outcome of sirolimus- and paclitaxel-eluting stents versus bare metal stents in patients with ST-segment elevation myocardial infarction (from the RESEARCH and T-SEARCH Registries). Am J Cardiol. 2007; 99 1027-1032
- 13 Bavry A A, Kumbhani D J, Helton T J, Borek P P, Mood G R, Bhatt D L. Late thrombosis of drug-eluting stents: a meta-analysis of randomized clinical trials. Am J Med. 2006; 119 1056-1061
- 14 McFadden E P, Stabile E, Regar E. et al . Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy. Lancet. 2004; 364 1519-1521
- 15 Iakovou I, Schmidt T, Bonizzoni E. et al . Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA. 2005; 293 2126-2130
- 16 Grines C L, Bonow R O, Casey D E. et al . Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians. J Am Coll Cardiol. 2007; 49 734-739
- 17 Urban P, Gershlick A H, Guagliumi G. et al . Safety of coronary sirolimus-eluting stents in daily clinical practice: one-year follow-up of the e-Cypher registry. Circulation. 2006; 113 1434-1441
- 18 Spertus J A, Kettelkamp R, Vance C. et al . Prevalence, predictors, and outcomes of premature discontinuation of thienopyridine therapy after drug-eluting stent placement: results from the PREMIER registry. Circulation. 2006; 113 2803-2809
- 19 Spaulding C, Daemen J, Boersma E. et al . A pooled analysis of data comparing sirolimus-eluting stents with bare-metal stents. N Engl J Med. 2007; 356 989-997
- 20 Fujii K, Carlier S G, Mintz G S. et al . Stent underexpansion and residual reference segment stenosis are related to stent thrombosis after sirolimus-eluting stent implantation An intravascular ultrasound study. J Am Coll Cardiol. 2005; 45 995-998
- 21 Joner M, Finn A V, Farb A. et al . Pathology of drug-eluting stents in humans Delayed healing and late thrombotic risk. J Am Coll Cardiol. 2006; 48 193-202
- 22 Bhatt D L, Fox K A, Hacke W. et al . and CHARISMA Investigators. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med. 2006; 354 1706-1717
- 23 Steinhubl S R, Berger P B, Mann T J, Fry E TA, DeLago A, Wilmer C, Topol E J. Early and sustained orasl antiplatelet therapy following percutaneous coronary intervention. A randomized Trial. JAMA. 2002; 288 2411-2420
- 24 Patrono C, Garcia R odriguez, Landolfi R, Baigent C. Low-dose aspirin for the prevention of atherothrombosis. N Engl J Med. 2005; 353 2373-2583
- 25 Jaffe R, Strauss B H. Late and very late thrombosis of drug-eluting stents. Evolving concepts and Perspectives. JACC. 2007; 50 119-127
- 26 Silber S, Albertsson P, Aviles F F. et al. and Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology . Guidelines for percutaneous coronary interventions. The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology. Eur Heart J. 2005; 26 804-847
- 27 Silber S. et al . Positionspapier der DGK zu Medikamenten-beschichteten Stents. Im Druck. ;
- 28 Holmes Jr D R, Kereiakes D J, Laskey W K. et al . Thrombosis and drug-eluting stents: an objective appraisal. J Am Coll Cardiol. 2007; 50 109-118
- 29 Geisler T, Langer H, Wydymus M. et al . Low response to clopidogrel is associated with cardiovascular outcome after coronary stent implantation. Eur Heart J. 2006; 27 2420-2425
- 30 Matetzky S, Shenkman B, Guetta V. et al . Clopidogrel resistance is associated with increased risk of recurrent atherothrombotic events in patients with acute myocardial infarction. Circulation. 2004; 109 3171-3175
- 31 Buonamici P, Marcucci R, Migliorini A. et al . Impact of platelet reactivity after clopidogrel administration on drug-eluting stent thrombosis. JACC. 2007; 49 2312-2317
- 32 Orford J L, Fasseas P, Melby S. et al . Safety and efficacy of aspirin, clopidogrel and warfarin after coronary stent placement in patients with and indication for anticoagulation. Am Heart J. 2004; 147 463-467
- 33 Rubboli A, Pasquale G. Optimal antithrombotic treatment in patients with an indication for long-term anticoagulation undergoing coronary artery stenting. Future Cardiol. 2006; 2 205-213
- 34 Brilakis E S, Banerjee S, Berger P B. Perioperative Management of Patients With Coronary Stents. JACC. 2007; 49 2145-2150
PD Dr. A. May
Medizinische Klinik III
Eberhard Karls Universität Tübingen
Otfried-Müller-Straße 10
72076 Tübingen
Telefon: 07071/29-83688
Fax: 07071/29-4473
eMail: andreas.may@med.uni-tuebingen.de