Akut coronaria szindrómán átesett thrombocytopeniás betegek thrombocytaaggregáció-gátló gyógyszeres kezelése

Osszefoglalo. Az akut coronaria szindroman (ACS) atesett betegek kezelesenek alappillere a kettős (aszpirin + klopidogrel ) thrombocytaaggregacio-gatlo kezeles. Az immunthrombocytopenias purpuras (ITP-s) betegek - es kulonosen azok, akik refrakter ITP miatt thrombopoetinanalog kezelesben reszesulnek - kulon elbiralast igenyelnek. 50-100 G/l thrombocytaszam kozotti es verzeses szovődmennyel nem rendelkező ACS-s betegeken a gyogyszerkibocsato stent beulteteset kovetően kettős thrombocytaaggregacio-gatlo kezelest csak 1 honapig kell alkalmazni (ez az időtartam atlagos verzeses rizikoju betegeken 1 ev), majd klopidogrel-monoterapia javasolt. Munkank soran a 2015. januar 1. es 2020. oktober 1. kozott a Semmelweis Egyetem I. Belgyogyaszati Klinikajan kezelt ITP-s betegek koreben vizsgaltuk az ACS előfordulasat es lefolyasat. Klinikankon az elmult 5 evben gondozott, 168 ITP-s beteg kozul 3 beteg eseteben alakult ki ACS. A refrakter ITP kezelesenek reszekent mind a 3 beteg thrombopoetinanalog - (2 beteg romiplosztim-, 1 beteg eltrombopag-) kezelesben reszesult. A 3 ITP-s betegunk egyikenel sem alakult ki verzeses szovődmeny a thrombopoetinanalog-kezeles es a thrombocytaaggregacio-gatlas mellett. Első betegunk eseteben 5 ev alatt harom alkalommal alakult ki ACS (egy izben femstentet es ket alkalommal gyogyszerkibocsato stentet kapott). A masodik betegnel ket alkalommal (1 ev kulonbseggel), a harmadik betegnel egy esetben tortent gyogyszerkibocsato stent beultetese. ITP es ACS egyuttes fennallasa eseten az akut es a hosszu tavu gyogyszeres kezeles egyeni merlegelest igenyel. Ezen specialis betegcsoport szamara a kezelesi iranyelv kidolgozasa megfontolando. Orv Hetil. 2021; 162(33): 1335-1340. Summary. Dual antiplatelet therapy (DAPT) consisting of aspirin and clopidogrel is essential in the treatment of acute coronary syndrome (ACS). Immune thrombocytopenic purpura (ITP) patients - and especially those receiving thrombopoietin analog (TPO) treatment - deserve special attention. In ACS patients with platelet counts between 50 G/L and 100 G/L and no bleeding symptoms, DAPT is indicated for 1 month after the placement of new generation drug-eluting stents (the length of treatment is 1 year in the case of patients with average bleeding risk) followed by clopidogrel monotherapy. In patients with average bleeding risk, DAPT is recommended for 1 year after the ACS. Our aim was to investigate the incidence and outcome of ACS in ITP patients, who were treated in our clinic between 1st January 2015 and 1st October 2020. Out of 168 patients treated for ITP, 3 patients suffered from ACS in the last 5 years. These patients received TPO treatment (2 patients subcutan romiplostim, 1 patient oral eltrombopag). None of these ITP patients treated with DAPT and with TPO analog suffered from bleeding complications. 1 patient developed ACS three times within the last 5 years (he received bare-metal stent once and drug-eluting stent twice). Drug-eluting stent was placed once in the third, and twice (with 1 year difference) in the second patient. Acute and long-term medication of patients suffering from both ITP and ACS is a challenging task and needs individual evaluation. Establishment of treatment guidelines for this special group is warranted. Orv Hetil. 2021; 162(33): 1335-1340.