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ASS und Clopidogrel bei urologischen Operationen

Perioperatives Management

ASA and clopidogrel for urological operations

Perioperative management

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Zusammenfassung

Nach einer Metananalyse an über 50.000 Patienten mit Sekundärprophylaxe nach einem kardialen Ereignis und Absetzen von Acetylsalicylsäure (ASS) traten 3-mal mehr kardiale Komplikationen auf als bei kontinuierlicher Plättchenhemmung; bei implantierten Koronarstents kann das Risiko für ein akutes Koronarsyndrom bis auf das 90-Fache ansteigen. Dabei spielt die Dauer einer ASS-Medikation für das kardiovaskuläre oder zerebrovaskuläre Ereignis keine Rolle. Es ist daher heute obsolet, ASS routinemäßig vor einer urologischen Operation abzusetzen, solange es sich nicht um eine primäre Indikation für die Thrombozytenaggregationshemmung handelt. Viele und häufige urologische Eingriffe (außer der ESWL) lassen sich auch ohne signifikante Erhöhung der Morbidität problemlos unter kontinuierlicher ASS-Gabe durchführen. Bei der dualen Hemmung mit zusätzlicher Clopidogrelgabe kann die Situation komplex sein; hier muss von Fall zu Fall mit dem Kardiologen gemeinsam entschieden werden.

Abstract

In a systematic overview and meta-analysis among more than 50,000 patients at risk for coronary artery disease, not adhering to or discontinuing aspirin (acetylsalicylic acid, ASA) was associated with a significantly increased risk of non-fatal myocardial infarction or death. Withdrawal of low dose aspirin was correlated with a threefold increase in the risk of adverse cardiovascular events. This risk is present irrespective of the length of time patients had been taking low dose aspirin. Therefore, in patients on chronic low dose aspirin for secondary prevention of cardiovascular disease, aspirin should never be discontinued. In the few available studies in urological surgery the increase in bleeding does not translate into a significant increase in specific morbidity. This seems to be also true for the additional administration of clopidogrel to aspirin. Nevertheless, in patients with drug-eluting stents and dual antiplatelet therapy, urologists should ensure a multidisciplinary management of the perioperative course.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. C. Fischer und G. Lümmen geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren

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Authors and Affiliations

  1. Urologische Klinik, Klinikum Bayreuth GmbH, Hohe Warte 8, 95445, Bayreuth, Deutschland

    C. Fischer

  2. Urologische Klinik, St. Josef-Hospital, Troisdorf, Deutschland

    G. Lümmen

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  1. C. Fischer
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  2. G. Lümmen
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Correspondence to C. Fischer.

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Fischer, C., Lümmen, G. ASS und Clopidogrel bei urologischen Operationen. Urologe 52, 1597–1605 (2013). https://doi.org/10.1007/s00120-013-3263-9

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  • DOI: https://doi.org/10.1007/s00120-013-3263-9

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