Antithrombozytäre Strategien in der kardiovaskulären Akut- und Langzeittherapie

@ Atherothrombotic diseases and especially coronary and cerebrovascular diseases are the most important causes of death in western countries. Besides the prevention and treatment of cardiovascular risk factors like hyperlipidemia, smoking and arterial hypertension along with improvements in the catheter-based interventional therapy, the treatment of cardiovascular dieases with platelet aggregation inhibitors improved the the patients' long-term outcome and mortality. The effect of acetylsalicylic acid (ASA) as an inhibitor of the cylooxygenase is well studied and proven in numerous major studies. In these trials, ASA improved prognosis of the patients both in acute and chronic coronary heart disease as well as in the primary prevention of high-risk patients. A similar positive and, in comparison to ASA, even stronger effect was demonstrated with thienopyridines as inhibitors of the ADP receptor on thrombocytes. In additional studies a combination of both substances showed a synergistic effect on platelet inhibition in the treatment of acute coronary syndromes and after stent implantation as interventional therapy of coronary heart disease. According to randomized prospective double-blind studies, a combination therapy with ASA and clopidogrel is indicated for patients with acute coronary syndromes and following coronary stent implantation for up to 12 months. A longer-lasting dual therapy is tested in several ongoing studies, along with the safety of this treatment regimen in combination with lytic therapy in acute myocardial infarction.