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Erschienen in: Die Diabetologie 8/2021

29.07.2021 | Stabile Angina pectoris | CME

Antithrombotische Therapie bei Diabetes mellitus

Diabetes mellitus und kardiovaskuläre Erkrankungen

verfasst von: Dr. med. Lukas Andreas Heger, Daniel Duerschmied

Erschienen in: Die Diabetologie | Ausgabe 8/2021

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Zusammenfassung

Die Atherosklerose als chronische, obstruierende Gefäßentzündung verläuft progredient mit – teils wiederkehrenden – kardiovaskulären Ereignissen („major adverse cardiovascular event“ [MACE]). Patienten mit Diabetes mellitus (DM) haben aufgrund einer stärkeren Thrombozytenreaktivität ein deutlich erhöhtes Risiko für rezidivierende MACE. Die antithrombotische Therapie gewinnt daher zunehmend an Bedeutung. Laut den Ergebnissen der COMPASS-Studie verringert eine duale antithrombotische Therapie (DAT) mit ASS (Azetylsalizylsäure) und dem Faktor-Xa-Inhibitor Rivaroxaban in niedriger, vaskulärer Dosierung das Auftreten von MACE bei Hochrisikopatienten deutlich. Alternativ ist für Hochrisikopatienten mit chronischem Koronarsyndrom („chronic coronary syndrome“ [CCS]) eine verlängerte, ggf. auch dauerhafte, duale antithrombozytäre Therapie (DAPT) möglich, auch wenn unter dieser keine signifikante Reduktion der Mortalität nachgewiesen ist.
Literatur
1.
Zurück zum Zitat Federation ID (2019) IDF diabetes atlas, 9. Aufl. International Diabetes Federation, Brussels Federation ID (2019) IDF diabetes atlas, 9. Aufl. International Diabetes Federation, Brussels
2.
Zurück zum Zitat Nesto RW (2004) Correlation between cardiovascular disease and diabetes mellitus: current concepts. Am J Med 116(Suppl 5A):11s–22sCrossRef Nesto RW (2004) Correlation between cardiovascular disease and diabetes mellitus: current concepts. Am J Med 116(Suppl 5A):11s–22sCrossRef
3.
Zurück zum Zitat Cavender MA, Steg PG, Smith SC Jr., Eagle K, Ohman EM, Goto S et al (2015) Impact of diabetes mellitus on hospitalization for heart failure, cardiovascular events, and death: outcomes at 4 years from the reduction of Atherothrombosis for continued health (REACH) registry. Circulation 132(10):923–931CrossRef Cavender MA, Steg PG, Smith SC Jr., Eagle K, Ohman EM, Goto S et al (2015) Impact of diabetes mellitus on hospitalization for heart failure, cardiovascular events, and death: outcomes at 4 years from the reduction of Atherothrombosis for continued health (REACH) registry. Circulation 132(10):923–931CrossRef
4.
5.
Zurück zum Zitat Cosentino F, Grant PJ, Aboyans V, Bailey CJ, Ceriello A, Delgado V et al (2020) 2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J 41(2):255–323CrossRef Cosentino F, Grant PJ, Aboyans V, Bailey CJ, Ceriello A, Delgado V et al (2020) 2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J 41(2):255–323CrossRef
6.
Zurück zum Zitat Weidmann L, Obeid S, Mach F, Shahin M, Yousif N, Denegri A et al (2019) Pre-existing treatment with aspirin or statins influences clinical presentation, infarct size and inflammation in patients with de novo acute coronary syndromes. Int J Cardiol 275:171–178CrossRef Weidmann L, Obeid S, Mach F, Shahin M, Yousif N, Denegri A et al (2019) Pre-existing treatment with aspirin or statins influences clinical presentation, infarct size and inflammation in patients with de novo acute coronary syndromes. Int J Cardiol 275:171–178CrossRef
7.
Zurück zum Zitat Anand SS, Bosch J, Eikelboom JW, Connolly SJ, Diaz R, Widimsky P et al (2018) Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial. Lancet 391(10117):219–229CrossRef Anand SS, Bosch J, Eikelboom JW, Connolly SJ, Diaz R, Widimsky P et al (2018) Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial. Lancet 391(10117):219–229CrossRef
8.
Zurück zum Zitat Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C et al (2020) 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J 41(3):407–477CrossRef Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C et al (2020) 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J 41(3):407–477CrossRef
9.
Zurück zum Zitat Eikelboom JW, Connolly SJ, Bosch J, Dagenais GR, Hart RG, Shestakovska O et al (2017) Rivaroxaban with or without aspirin in stable cardiovascular disease. N Engl J Med 377(14):1319–1330CrossRef Eikelboom JW, Connolly SJ, Bosch J, Dagenais GR, Hart RG, Shestakovska O et al (2017) Rivaroxaban with or without aspirin in stable cardiovascular disease. N Engl J Med 377(14):1319–1330CrossRef
10.
Zurück zum Zitat Capell WH, Bonaca MP, Nehler MR, Chen E, Kittelson JM, Anand SS et al (2018) Rationale and design for the Vascular Outcomes study of ASA along with rivaroxaban in endovascular or surgical limb revascularization for peripheral artery disease (VOYAGER PAD). Am Heart J 199:83–91CrossRef Capell WH, Bonaca MP, Nehler MR, Chen E, Kittelson JM, Anand SS et al (2018) Rationale and design for the Vascular Outcomes study of ASA along with rivaroxaban in endovascular or surgical limb revascularization for peripheral artery disease (VOYAGER PAD). Am Heart J 199:83–91CrossRef
11.
Zurück zum Zitat Eikelboom JW, Bosch JJ, Connolly SJ, Shestakovska O, Dagenais GR, Hart RG et al (2019) Major bleeding in patients with coronary or peripheral artery disease treated with Rivaroxaban plus aspirin. J Am Coll Cardiol 74(12):1519–1528CrossRef Eikelboom JW, Bosch JJ, Connolly SJ, Shestakovska O, Dagenais GR, Hart RG et al (2019) Major bleeding in patients with coronary or peripheral artery disease treated with Rivaroxaban plus aspirin. J Am Coll Cardiol 74(12):1519–1528CrossRef
12.
Zurück zum Zitat Zeymer U, Riedel K, Hahn M (2017) Medical therapy and recurrent Ischemic events in high risk patients surviving their myocardial infarction for at least 12 months: comparison of patients with ST elevation versus non-ST elevation myocardial infarction. Cardiol Ther 6(2):273–280CrossRef Zeymer U, Riedel K, Hahn M (2017) Medical therapy and recurrent Ischemic events in high risk patients surviving their myocardial infarction for at least 12 months: comparison of patients with ST elevation versus non-ST elevation myocardial infarction. Cardiol Ther 6(2):273–280CrossRef
13.
Zurück zum Zitat Bansilal S, Bonaca MP, Cornel JH, Storey RF, Bhatt DL, Steg PG et al (2018) Ticagrelor for secondary prevention of Atherothrombotic events in patients with multivessel coronary disease. J Am Coll Cardiol 71(5):489–496CrossRef Bansilal S, Bonaca MP, Cornel JH, Storey RF, Bhatt DL, Steg PG et al (2018) Ticagrelor for secondary prevention of Atherothrombotic events in patients with multivessel coronary disease. J Am Coll Cardiol 71(5):489–496CrossRef
14.
Zurück zum Zitat Choi SY, Kim MH, Cho YR, Park SJ, Lee MK, Park TH et al (2018) Performance of PRECISE-DAPT score for predicting bleeding complication during dual Antiplatelet therapy. Circ Cardiovasc Interv 11(12):e6837CrossRef Choi SY, Kim MH, Cho YR, Park SJ, Lee MK, Park TH et al (2018) Performance of PRECISE-DAPT score for predicting bleeding complication during dual Antiplatelet therapy. Circ Cardiovasc Interv 11(12):e6837CrossRef
15.
Zurück zum Zitat Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L et al (2020) 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 41(1):111–188CrossRef Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L et al (2020) 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 41(1):111–188CrossRef
16.
Zurück zum Zitat Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE et al (2017) 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 Cardiol 69(11):e71–e126CrossRef Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE et al (2017) 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 Cardiol 69(11):e71–e126CrossRef
17.
Zurück zum Zitat Halliday A, Bax JJ (2018) The 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 55(3):301–302CrossRef Halliday A, Bax JJ (2018) The 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 55(3):301–302CrossRef
18.
Zurück zum Zitat A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet. 1996;348(9038):1329–39. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet. 1996;348(9038):1329–39.
19.
Zurück zum Zitat Bonaca MP, Bauersachs RM, Anand SS, Debus ES, Nehler MR, Patel MR et al (2020) Rivaroxaban in peripheral artery disease after revascularization. N Engl J Med 382(21):1994–2004CrossRef Bonaca MP, Bauersachs RM, Anand SS, Debus ES, Nehler MR, Patel MR et al (2020) Rivaroxaban in peripheral artery disease after revascularization. N Engl J Med 382(21):1994–2004CrossRef
20.
Zurück zum Zitat Frank U, Nikol S, Belch J, Boc V, Brodmann M, Carpentier PH et al (2019) ESVM Guideline on peripheral arterial disease. VASA 48(Suppl 102):1–79PubMed Frank U, Nikol S, Belch J, Boc V, Brodmann M, Carpentier PH et al (2019) ESVM Guideline on peripheral arterial disease. VASA 48(Suppl 102):1–79PubMed
21.
Zurück zum Zitat Wiviott SD, Braunwald E, Angiolillo DJ, Meisel S, Dalby AJ, Verheugt FW et al (2008) Greater clinical benefit of more intensive oral antiplatelet therapy with prasugrel in patients with diabetes mellitus in the trial to assess improvement in therapeutic outcomes by optimizing platelet inhibition with prasugrel-Thrombolysis in Myocardial Infarction 38. Circulation 118(16):1626–1636CrossRef Wiviott SD, Braunwald E, Angiolillo DJ, Meisel S, Dalby AJ, Verheugt FW et al (2008) Greater clinical benefit of more intensive oral antiplatelet therapy with prasugrel in patients with diabetes mellitus in the trial to assess improvement in therapeutic outcomes by optimizing platelet inhibition with prasugrel-Thrombolysis in Myocardial Infarction 38. Circulation 118(16):1626–1636CrossRef
22.
Zurück zum Zitat Heger LA, Danzer M, Bode C, Hortmann M, Duerschmied D, Olivier CB et al (2020) Dual-pathway antithrombotic therapy in patients with atrial fibrillation after percutaneous coronary intervention in stable coronary artery disease: a single-center, single-operator, retrospective cohort study. Front Med 7:414CrossRef Heger LA, Danzer M, Bode C, Hortmann M, Duerschmied D, Olivier CB et al (2020) Dual-pathway antithrombotic therapy in patients with atrial fibrillation after percutaneous coronary intervention in stable coronary artery disease: a single-center, single-operator, retrospective cohort study. Front Med 7:414CrossRef
23.
Zurück zum Zitat Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomstrom-Lundqvist C et al (2021) 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 42(5):373–498CrossRef Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomstrom-Lundqvist C et al (2021) 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 42(5):373–498CrossRef
24.
Zurück zum Zitat Malhotra K, Ishfaq MF, Goyal N, Katsanos AH, Parissis J, Alexandrov AW et al (2019) Oral anticoagulation in patients with chronic kidney disease: a systematic review and meta-analysis. Neurology 92(21):e2421–e2431CrossRef Malhotra K, Ishfaq MF, Goyal N, Katsanos AH, Parissis J, Alexandrov AW et al (2019) Oral anticoagulation in patients with chronic kidney disease: a systematic review and meta-analysis. Neurology 92(21):e2421–e2431CrossRef
Metadaten
Titel
Antithrombotische Therapie bei Diabetes mellitus
Diabetes mellitus und kardiovaskuläre Erkrankungen
verfasst von
Dr. med. Lukas Andreas Heger
Daniel Duerschmied
Publikationsdatum
29.07.2021
Verlag
Springer Medizin
Erschienen in
Die Diabetologie / Ausgabe 8/2021
Print ISSN: 2731-7447
Elektronische ISSN: 2731-7455
DOI
https://doi.org/10.1007/s11428-021-00796-y

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