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Das Konzept der prähospitalen Thrombolyse

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Die Notfalltherapie bei akutem Myokardinfarkt

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Abstract

Intravenous thrombolysis has become a standard in treatment of acute myocardial infarction. Efficacy of thrombolysis is strictly time dependent. It has been shown in several studies that the most benefit in terms of myocardial salvage and short- and long-term mortality is achieved with initiation of therapy within the first 60–90 minutes after onset of symptoms. Nearly exlusively, prehospital initiation of thrombolysis makes it possible to take advantage of this early time window. Moreover, randomized studies yielded a better outcome when a time gain of ≥ 90 minutes was achieved. Since it has been shown that prehospital diagnosis of an acute myocardial infarction is reliable and out-of-hospital initiation of therapy has no additional specific risk, patients seen within the first 60–90 minutes after onset of symptoms or for whom a relevant time gain ≥ 90 minutes can be expected are ideal candidates for, and therefore should receive, prehospital thrombolysis. In places where acute intervention (e.g., PTCA) is available, protocols should be developed which take the specific time windows into consideration.

Zusammenfassung

Die Thrombolysetherapie hat sich in den letzten 20 Jahren zum Standard der Akutbehandlung des Infarkts entwickelt, an der sich andere Therapieverfahren — messen lassen müssen. Die Effizienz der Reperfusionstherapie durch Thrombolyse ist ausgeprägt zeitabhängig. Experimentelle und klinische Daten sprechen dafür, dass bei Be- ginn der Therapie in den ersten 60 bis 90 Minuten nach Symptombeginn der Nutzen exponentiell ansteigt. Dieses Zeitfenster steht praktisch ausschließlich bei prähospitalem Beginn der Thrombolyse zur Verfügung. Darüber hinaus wurde gezeigt, dass bei einem Zeitgewinn von 90 und mehr Minuten die prähospitale Thrombolyse auch bei späterem Therapiebeginn zu besseren Ergebnissen führt als Beginn der Therapie erst bei Krankenhausaufnahme. Die prähospitale Diagnose des akuten Infarkts ist mit großer Verläßlichkeit möglich. Eine erhöhte Komplikationsrate wurde nicht beobachtet. Patienten, die innerhalb der ersten 60 bis 90 Minuten nach Symptombeginn behandelt werden können bzw. bei denen ein Zeitgewinn von ≥ 90 Minuten möglich ist, sollten deshalb eine Thrombolysetherapie schon in der prähospitalen Phase der Versorgung erhalten. Steht als Alternative die Akutintervention zur Verfügung, so sollten spezifische Absprachen unter Berücksichtigung der zu erwartenden Zeitfenster erfolgen.

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  1. Klinikum Benjamin Franklin, Med. Klinik II, Hindenburgdamm 30, D-12200, Berlin, Deutschland

    Priv.-Doz. Dr. med. H.-R. Arntz

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  1. Klinikum Benjamin Franklin, Medizinische Klinik II, Hindenburgdamm 30, D-12200, Berlin, Germany

    H.-R. Arntz

  2. Städtisches Krankenhaus Hildesheim Medizinische Klinik I, Akademisches Lehrkrankenhaus der Medizinischen Hochschule Hannover, Weinberg 1, D-31134, Hildesheim, Germany

    H.-P. Schuster

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Arntz, HR. (2000). Das Konzept der prähospitalen Thrombolyse. In: Arntz, HR., Schuster, HP. (eds) Die Notfalltherapie bei akutem Myokardinfarkt. Steinkopff, Heidelberg. https://doi.org/10.1007/978-3-642-57713-0_6

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  • DOI: https://doi.org/10.1007/978-3-642-57713-0_6

  • Publisher Name: Steinkopff, Heidelberg

  • Print ISBN: 978-3-7985-1247-4

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