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Thrombolytische Therapie des akuten Myokardinfarktes

  • Conference paper
Fachübergreifende Aspekte der Hämostaseologie III

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Zusammenfassung

Ein akuter Myokardinfarkt läßt sich in etwa 90% der Fälle ursächlich auf eine okkludierende Koronarthrombose zurückführen [29]. Das von der betroffenen Koronararterie versorgte Myokardareal wird innerhalb weniger Stunden nekrotisch, falls es nicht ausnahmsweise ausreichend über Kollateralen versorgt wird. Es bildet sich eine Myokardnarbe, wodurch die linksventri- kuläre Funktion irreversibel eingeschränkt wird. Für die Langzeitprognose des Patienten ist die Einschränkung der linksventrikulären Pumpfunktion ein entscheidender Parameter, wenn die akute Infarktphase mit ihren Komplikationen überlebt wird. Unter der Vorstellung, diesen Ablauf der Ereignisse möglichst frühzeitig zu unterbrechen, werden seit Ende der 70 er Jahre Reka- nalisationsmaßnahmen wie eine Thrombolyse und/oder eine interventionelle Ballondilatation (PTCA) und gegebenenfalls eine Stentimplantation durchgeführt. In mehreren placebokontrollierten, doppelblinden Megastudien [1, 2, 46, 47, 61, 104] konnte in der 2. Hälfte der 80 er Jahre für unterschiedliche thrombolytische Substanzen nachgewiesen werden, daß eine rechtzeitige thrombolytische Therapie die Infarktgröße limitiert, die linksventrikuläre Pumpfunktion besser erhält und die Mortalitätsrate des akuten Myokardinfarktes signifikant senkt [34]. Ein wiedereröffnetes Koronargefäß scheint auch die Inzidenz schwerer Rhythmusstörungen sowie der linksventrikulären Dilatation günstig zu beeinflussen [64]. Aufgrund dieser Daten wurde die Thrombolyse zur Standardtherapie des akuten Myokardinfarktes.

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  1. M. Moser
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  2. C. Bode
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  1. Klinik für Anästhesiologie, Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Eike Martin

  2. Medizinische Klinik I, Universität Heidelberg, Bergheimer Straße 58, 69115, Heidelberg, Germany

    Peter Nawroth

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Moser, M., Bode, C. (1998). Thrombolytische Therapie des akuten Myokardinfarktes. In: Martin, E., Nawroth, P. (eds) Fachübergreifende Aspekte der Hämostaseologie III. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-72275-2_2

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  • DOI: https://doi.org/10.1007/978-3-642-72275-2_2

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-64815-4

  • Online ISBN: 978-3-642-72275-2

  • eBook Packages: Springer Book Archive

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