Advertisement

Prä-, peri- und postinterventionelle Antikoagulation

  • S. Steiner

Zusammenfassung

Die antithrombotische Therapie ist ein Eckpfeiler in der Behandlung von Patienten mit symptomatischer pAVK auf Basis atherosklerotischer Gefäßveränderungen. Ziele einer antithrombotischen Therapie bei pAVK umfassen die Reduktion kardiovaskulärer Ereignisse wie Herzinfarkt und Schlaganfall aber auch die Verhinderung einer Progression der pAVK selbst. Basis dieser Dauertherapie sind in erster Linie die Thrombozytenaggregationshemmer Aspirin und Clopidogrel. Wesentlich ist aber auch das antithrombotische Management im Rahmen einer peripheren Intervention, wobei hier in erster Linie Heparine zum Einsatz kommen. Nach endovaskulären Eingriffen stellt sich die Frage der Intensität und Dauer einer Antikoagulation in Abhängigkeit von Lokalisation und Art der peripheren Intervention. Ziel ist es, durch die Senkung von Rezidivereignissen Offenheitsraten und -dauer zu verbessern.

Literatur

  1. Aboyans et al. (2017) ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries Endorsed by: the European Stroke Organization (ESO) The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J. 2017 Aug 26. doi: 10.1093/eurheartj/ehx095. [Epub ahead of print]CrossRefGoogle Scholar
  2. Alonso-Coello P, et al. (2012) Antithrombotic therapy in peripheral artery disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2 Suppl):e669S–90SGoogle Scholar
  3. Anand SS et al. (2017) Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial. Lancet 2017 Nov 10. pii: S0140-6736(17)32409-1. doi: 10.1016/S0140-6736(17) 32409-1. [Epub ahead of print]
  4. Antithrombotic Trialists Collaboration (2002) Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 324(7329):71–86CrossRefPubMedCentralGoogle Scholar
  5. Committee Caprie Steering (1996) A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet 348(9038):1329–39Google Scholar
  6. Dake MD, et al. (2011) Paclitaxel-eluting stents show superiority to balloon angioplasty and bare metal stents in femoropopliteal disease: twelve-month Zilver PTX randomized study results. Circ Cardiovasc Interv 4(5):495–504Google Scholar
  7. Dalainas I, et al. (2006) Dual antiplatelet regime versus acetyl-acetic acid for carotid artery stenting. Cardiovascular and interventional radiology 29(4):519–21CrossRefPubMedGoogle Scholar
  8. Donovan RJ, et al. (2016) Adjunctive anticoagulation during peripheral vascular intervention. Am Heart J 172:106–14CrossRefPubMedGoogle Scholar
  9. Efeovbokhan N, et al. (2014) An objective comparison between bivalirudin and heparin during peripheral vascular interventions. Future cardiology 10(6):717–24CrossRefPubMedGoogle Scholar
  10. Eikelboom JW et al. (2017) Rivaroxaban with or without Aspirin in Stable Cardiovascular Disease. N Engl J Med 377:1319–1330Google Scholar
  11. Gerhard-Herman MD, et al. (2016) 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll CardiolGoogle Scholar
  12. Hiatt WR, et al. (2017) Ticagrelor versus Clopidogrel in Symptomatic Peripheral Artery Disease. N Engl J Med 376(1):32–40Google Scholar
  13. Hyhlik-Durr A, et al. (2012) Technical aspects of EVAR for infrarenal AAA. J Cardiovasc Surg (Torino) 53(1 Suppl 1):111–8Google Scholar
  14. Lip GY, et al. (2014) Management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous coronary or valve interventions: a joint consensus document of the European Society of Cardiology Working Group on Thrombosis, European Heart Rhythm Association (EHRA), European Association of Percutaneous Cardiovascular Interventions (EAPCI) and European Association of Acute Cardiac Care (ACCA) endorsed by the Heart Rhythm Society (HRS) and Asia-Pacific Heart Rhythm Society (APHRS). Eur Heart J 35(45): 3155–79Google Scholar
  15. McKevitt FM, et al. (2005) The benefits of combined anti-platelet treatment in carotid artery stenting. European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 29(5):522–7CrossRefPubMedGoogle Scholar
  16. Morrow DA, et al. (2012) Vorapaxar in the secondary prevention of atherothrombotic events. N Engl J Med 366(15):1404–13CrossRefPubMedGoogle Scholar
  17. Norgren L, et al. (2007) Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg 45 Suppl S:S5–67CrossRefPubMedGoogle Scholar
  18. Peeters Weem SMO, et al. (2016) Lack of Evidence for Dual Antiplatelet Therapy after Endovascular Arterial Procedures: A Meta-analysis. European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 52(2):253–62CrossRefPubMedGoogle Scholar
  19. Rosenfield K, et al. (2015) Trial of a Paclitaxel-Coated Balloon for Femoropopliteal Artery Disease. N Engl J Med 373(2):145–53Google Scholar
  20. Tepe G, et al. (2015) Drug-coated balloon versus standard percutaneous transluminal angioplasty for the treatment of superficial femoral and popliteal peripheral artery disease: 12-month results from the IN.PACT SFA randomized trial. Circulation 131(5):495–502CrossRefPubMedGoogle Scholar
  21. Tepe G, et al. (2012) Management of peripheral arterial interventions with mono or dual antiplatelet therapy – the MIRROR study: a randomised and double-blinded clinical trial. European radiology 22(9):1998–2006CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Deutschland 2018

Authors and Affiliations

  1. 1.Abteilung für Interventionelle AngiologieUniversitätsklinikum LeipzigLeizpigDeutschland

Personalised recommendations