Hamostaseologie 2011; 31(02): 73-76
DOI: 10.5482/ha-1141
Übersichtsarbeit
Schattauer GmbH

Neue Ansätze und Indikationen zur Plättchenfunktionsdiagnostik in der Kardiologie

New approaches and indications for the analysis of platelet function in cardiology
B. Ivandic
1   synlab Medizinisches Versorgungszentrum Heidelberg GmbH, Eppellheim
2   DIAneering® – Diagnostics Engineering & Research GmbH, Dossenheim
,
N. Frey
3   Klinik für Innere Medizin III, Universitätsklinikum Schleswig-Holstein, Campus Kiel
› Author Affiliations
Further Information

Publication History



09 December 2010

Publication Date:
28 December 2017 (online)

Summary

Inhibiting platelet function is a key therapeutic principle in cardiology because platelets play a pivotal role in triggering cardiovascular events. In addition to acetylsalicylic acid, a cyclooxygenase inhibitor, ADP-receptor blockers are frequently used for anti-platelet therapy. This therapy does not abolish platelet activation and aggregation. Platelets may still be activated by alternative routes such as the thrombin receptor-mediated pathway. New, more potent inhibitors of platelet function continue to lower the risk of ischaemic events but several trials and clinical registries have also shown that this advantage was frequently offset by an increased risk of bleeding complications. As a consequence, the individual risk of ischaemia and bleeding of a patient must be taken into consideration to select the platelet inhibitor offering the best benefit-risk ratio. Modern laboratory diagnostics may help to achieve this goal by complementing functional platelet tests with pharmacogenomic analyses consistent with the idea of „personalized medicine“.

Zusammenfassung

Der Thrombozyt spielt eine zentrale Rolle in der Entstehung kardiovaskulärer Ereignisse, die Beeinflussung seiner Funktion ist daher wichtiges therapeutisches Ziel. Neben dem Cyclooxygenasehemmer ASS werden nach koronarer Stentimplantation bzw. bei akuten Koronarsyndromen zusätzlich ADP-Rezeptorblocker als Thrombozytenaggregationshemmer eingesetzt. Dabei wird der Thrombozyt nicht vollständig inhibiert; er kann noch über Alternativwege, beispielsweise thrombinrezeptorvermittelt aktiviert werden. Neue potentere Plättchenfunktionshemmer führen zu einer stetigen Verringerung des Risikos für ischämische Ereignisse. Eine Reihe von Studien und Registern zeigt aber auch, dass dieser Vorteil häufig mit dem Nachteil einer erhöhten Blutungskomplikationsrate erkauft werden muss. Das Ziel sollte daher eine möglichst individuelle Einschätzung des Ischämie-bzw. Blutungsrisikos der Patienten sein, um das Medikament mit dem besten Nutzen-RisikoVerhältnis zu wählen. Ein Ansatz hierzu könnte die moderne Labordiagnostik sein, welche künftig neben der funktionellen Thrombozytenuntersuchung auch die Bestimmung pharmakogenetisch relevanter Genloci im Rahmen der “personalized medicine” erlaubt.

 
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