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Gerinnungsaktive Begleittherapie

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Thrombolyse und Antikoagulation in der Kardiologie

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Zusammenfassung

Theoretische Erwägungen ebenso wie Ex-vivo- und tierexperimentelle Untersuchungen lassen in Kombination mit einer wirksamen Antikoagulation eine Verbesserung der klinischen Ergebnisse der Thrombolysetherapie erwarten. Aus klinischen Studien geht hervor, daß die frühe Offenheitsrate der Plasminogenaktivatoren in unterschiedlicher Weise durch Heparin beeinflußt wird. So findet sich für Pro-urokinase eine signifikant bessere Wirksamkeit bei gleichzeitiger Heparingabe, während für Streptokinase und rt-PA keine wesentliche Steigerung der frühen Offenheitsraten gezeigt werden kann.

Rezidivverschlüsse nach Thrombolysetherapie sind meist durch einen Rezidivthrombus bedingt und erscheinen daher ebenfalls durch eine konsequente Antikoagulationstherapie günstig beeinflußbar. Insbesondere nach rt-PA-Therapie läßt sich die Rate der frühen Reokklusionen durch Heparin signifikant senken. Aufgrund der ausgeprägten Selbstantikoagulation bei Streptokinasetherapie scheint die adjuvante Heparintherapie bei diesen Patienten hingegen prinzipiell verzichtbar. Mit zunehmendem Abstand zum Infarktereignis verliert Heparin jedoch hinsichtlich der Rezidivprophylaxe an Wirksamkeit, während Aspirin für die Langzeittherapie an Bedeutung gewinnt. In der Hospitalphase nach Herzinfarkt kann daher die gleichzeitige Therapie mit Heparin und Aspirin empfohlen werden. Die geringe Erhöhung hämorrhagischer Komplikationen wird durch den klinischen Vorteil aufgewogen.

Neue, spezifischer und stärker wirksame Antithrombotika (Plättchenrezep-torantagonisten, spezifische Antithrombine etc.) sind derzeit Gegenstand der experimentellen und klinischen Forschung. Ihr Stellenwert und ihre Risiken lassen sich derzeit noch nicht endgültig abschätzen.

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Authors
  1. D. C. Gulba
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  2. R. Dechend
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  3. M. Friedrich
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  4. R. Dietz
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Editors and Affiliations

  1. Abt. für Innere Medizin, William-Harvey-Klinik, Kaiserberg 6, Bad Nauheim, 61231, Deutschland

    Viola Hach-Wunderle

  2. Abt. Innere Medizin II, Städtische Kliniken Kassel, Mönchebergstraße 41–43, Kassel, 34125, Deutschland

    K.-L. Neuhaus

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© 1994 Springer-Verlag Berlin Heidelberg

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Gulba, D.C., Dechend, R., Friedrich, M., Dietz, R. (1994). Gerinnungsaktive Begleittherapie. In: Hach-Wunderle, V., Neuhaus, KL. (eds) Thrombolyse und Antikoagulation in der Kardiologie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-46810-0_7

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  • DOI: https://doi.org/10.1007/978-3-642-46810-0_7

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-58295-3

  • Online ISBN: 978-3-642-46810-0

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