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01.10.2009 | Leitthema

Perioperatives Management von Patienten mit Koronarstents bei nichtherzchirurgischen Eingriffen

verfasst von: Dr. Dr. C. Jámbor, M. Spannagl, B. Zwissler

Erschienen in: Die Anaesthesiologie | Ausgabe 10/2009

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Zusammenfassung

Bei Patienten mit Koronarstents, die operiert werden müssen, stellt sich die Frage, ob und wie die Thrombozytenaggregationshemmung fortgesetzt werden soll. Dabei gilt es, das Risiko perioperativer Blutungen gegen das einer akuten Stentthrombose abzuwägen. Das Blutungsrisiko hängt in erster Linie von der Art der geplanten Operation und von den Komorbiditäten des Patienten ab. Das Thromboserisiko ist aufgrund der thrombogenen Oberfläche der Stents erhöht. Dabei spielen die Zeitdauer, die seit der Stentimplantation vergangen ist, die Art des Stents [unbeschichtet („bare-metal stent“, BMS) oder beschichtet (z. B. „drug-eluting stent“, DES)] sowie angiographische und klinische Patientenfaktoren eine Rolle. Die perioperative antiaggregatorische Therapie muss daher bei jedem Patienten individuell angepasst werden. Ein „Bridging“ mit Heparin ist unwirksam. Die Zeit der perioperativen Unterbrechung der oralen Antiplättchentherapie kann bei Hochrisikopatienten mit i.v. Thromobozytenaggregationshemmern überbrückt werden. Ob ein bettseitiges Monitoring der Thrombozytenfunktion die perioperative Führung dieser Patienten verbessern und zur Reduktion von Komplikationen beitragen kann, ist Gegenstand aktueller Studien.

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Titel: Perioperatives Management von Patienten mit Koronarstents bei nichtherzchirurgischen Eingriffen
verfasst von: Dr. Dr. C. Jámbor
M. Spannagl
B. Zwissler
Publikationsdatum: 01.10.2009
Verlag: Springer-Verlag
Erschienen in: Die Anaesthesiologie / Ausgabe 10/2009
Print ISSN: 2731-6858
Elektronische ISSN: 2731-6866
DOI: https://doi.org/10.1007/s00101-009-1628-7

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