{"id":10427,"date":"2019-11-06T04:49:00","date_gmt":"2019-11-06T03:49:00","guid":{"rendered":"http:\/\/news-papers.eu\/?p=10427"},"modified":"2019-10-23T09:58:53","modified_gmt":"2019-10-23T07:58:53","slug":"teil-2-was-gibt-es-neues-aus-der-kardiologie-fuer-die-notfallmedizin","status":"publish","type":"post","link":"https:\/\/news-papers.eu\/?p=10427","title":{"rendered":"Teil 2: Was gibt es Neues aus der Kardiologie f\u00fcr die Notfallmedizin?"},"content":{"rendered":"<p style=\"text-align: justify;\"><strong><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"5528\" data-permalink=\"https:\/\/news-papers.eu\/?attachment_id=5528\" data-orig-file=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2017\/10\/Herz-e1504333340423.png?fit=300%2C201&amp;ssl=1\" data-orig-size=\"300,201\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Herz\" data-image-description=\"\" data-image-caption=\"\" data-large-file=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2017\/10\/Herz-e1504333340423.png?fit=1024%2C685&amp;ssl=1\" class=\"size-medium wp-image-5528 alignright\" src=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2017\/10\/Herz.png?resize=300%2C201\" alt=\"\" width=\"300\" height=\"201\" \/>Ein Beitrag von PD Dr. J\u00fcrgen Knapp, Bern\/Schweiz:\u00a0<\/strong><\/p>\n<p style=\"text-align: justify;\"><strong>Sch\u00fcpke S et al. <\/strong><strong>Ticagrelor or Prasugrel in Patients with Acute Coronary Syndromes. <\/strong><strong>N Engl J Med 2019; 381:1524-34; <\/strong><strong>DOI: 10.1056\/NEJMoa1908973<\/strong><\/p>\n<p style=\"text-align: justify;\">Die pr\u00e4hospitale Gabe eines zweiten Thrombozytenaggregationshemmers beim \u201eSTEMI\u201c (oder besser: okklusiven Myokardinfarkt, OMI) ist zwar bei den im deutschsprachigen Raum \u00fcblichen Transportzeiten nicht notwendig und \u00fcblich, aber f\u00fcr die innerklinische Notfallmedizin daf\u00fcr umso relevanter. Nachdem erst vor wenigen Jahren Ticagrelor (z.B. Brilique\u00ae) das Clopidogrel (z.B. Plavix\u00ae) f\u00fcr die meisten notfallm\u00e4\u00dfigen Katheterinterventionen bei OMI-Patienten abgel\u00f6st hat (mit Ausnahme der Patienten, die unter oraler Antikoagulation, z.B. Marcumar oder NOAK, stehen), sind nun die Ergebnisse der <strong>ISAR-REACT 5-Studie<\/strong> erschienen. Hier wurde im Rahmen der Katheterintervention von Patienten mit akutem Koronarsyndrom (ACS) die Gabe von Ticagrelor verglichen mit Prasugrel (z.B. Efient\u00ae).<\/p>\n<ul>\n<li>randomisierte Multicenter-Studie<\/li>\n<li>randomisiert wurden Patienten mit ACS, die f\u00fcr eine Katheterintervention vorbereitet wurden<\/li>\n<li>die Patienten erhielten im Rahmen der Katheterintervention als zweiten Thrombozytenhemmer zus\u00e4tzlich zum ASS entweder Ticagrelor (180 mg loading dose und 2 x 90 mg pro Tag als Erhaltungsdosis) oder Prasugrel (60 mg loading dose und 1 x 10 mg pro Tag als Erhaltungsdosis bzw. 1 x 5 mg bei Alter&gt;75 Jahre oder Gewicht &lt;60 kg)<\/li>\n<li>prim\u00e4rer (zusammengesetzter) Endpunkt: Auftreten von Tod, Myokardinfarkt oder Schlaganfall 1 Jahr nach der Randomisierung<\/li>\n<li>sekund\u00e4rer Endpunkt: Blutungskomplikationen<\/li>\n<li>n=4.018 Patienten wurden randomisiert, 41% der randomisierten Patienten wiesen einen STEMI auf, 46% einen NSTEMI und ca. 13% eine instabile Angina pectoris<\/li>\n<li>ein Ereignis des prim\u00e4ren Endpunktes trat bei 184 der 2.012 (9,3%) Patienten auf, die mit Ticagrelor behandelt wurden, im Vergleich zu 137 der 2.006 (6,9%) Patienten, die mit Prasugrel behandelt wurden.<\/li>\n<li>Das entspricht einer Risikoerh\u00f6hung um den Faktor 1,36 mit einem 95%-Konfidenzintervall von 1,09 bis 1,70, p=0,006<\/li>\n<li>aufgetrennt nach den einzelnen Ereignissen ergaben sich folgende Zahlen:<\/li>\n<\/ul>\n<p><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"10433\" data-permalink=\"https:\/\/news-papers.eu\/?attachment_id=10433\" data-orig-file=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/11\/Bildschirmfoto-2019-10-23-um-10.53.06.png?fit=946%2C200&amp;ssl=1\" data-orig-size=\"946,200\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Bildschirmfoto 2019-10-23 um 10.53.06\" data-image-description=\"\" data-image-caption=\"\" data-large-file=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/11\/Bildschirmfoto-2019-10-23-um-10.53.06.png?fit=946%2C200&amp;ssl=1\" class=\"alignnone wp-image-10433\" src=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/11\/Bildschirmfoto-2019-10-23-um-10.53.06.png?resize=705%2C148\" alt=\"\" width=\"705\" height=\"148\" srcset=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/11\/Bildschirmfoto-2019-10-23-um-10.53.06.png?resize=300%2C63&amp;ssl=1 300w, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/11\/Bildschirmfoto-2019-10-23-um-10.53.06.png?resize=768%2C162&amp;ssl=1 768w, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/11\/Bildschirmfoto-2019-10-23-um-10.53.06.png?resize=750%2C159&amp;ssl=1 750w, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2019\/11\/Bildschirmfoto-2019-10-23-um-10.53.06.png?w=946&amp;ssl=1 946w\" sizes=\"auto, (max-width: 705px) 100vw, 705px\" \/><\/p>\n<ul>\n<li>hinsichtlich der Blutungskomplikationen gab es keinen statistisch signifikanten Unterscheid zwischen den beiden Gruppen: 5,4% in der Ticagrelor-Gruppe vs. 4,8% in der Prasugrel-Gruppe<\/li>\n<li>das entspricht einer Risikoerh\u00f6hung um den Faktor 1,12 mit einem 95%-Konfidenzintervall von 0,83 bis 1,51, p=0,46<\/li>\n<\/ul>\n<p><strong>Fazit:<\/strong><\/p>\n<p style=\"text-align: justify;\">Eventuell erleben wir bald den n\u00e4chsten Wechsel bei der dualen Pl\u00e4ttchenhemmung beim ACS, weg vom Ticagrelor hin zum Prasugrel.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Ein Beitrag von PD Dr. J\u00fcrgen Knapp, Bern\/Schweiz:\u00a0 Sch\u00fcpke S et al. Ticagrelor or Prasugrel in Patients with Acute Coronary Syndromes. N Engl J Med 2019; 381:1524-34; DOI: 10.1056\/NEJMoa1908973 Die [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":5528,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"__cvm_playback_settings":[],"__cvm_video_id":"","jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"_wpas_customize_per_network":false},"categories":[1079],"tags":[85],"class_list":["post-10427","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-kardiovaskulaerer-notfall","tag-antikoagulation"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2017\/10\/Herz-e1504333340423.png?fit=300%2C201&ssl=1","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p7fR2g-2Ib","jetpack-related-posts":[{"id":9365,"url":"https:\/\/news-papers.eu\/?p=9365","url_meta":{"origin":10427,"position":0},"title":"Doppelte h\u00e4lt besser: Pl\u00e4ttchen-Hemmung bei \u201eSTEMI\u201c schon pr\u00e4hospital?","author":"Michael Bernhard","date":"Mai 12, 2019","format":false,"excerpt":"Ein Beitrag von PD Dr. J\u00fcrgen Knapp, Bern\/Schweiz: Eine sehr beliebte Diskussion in der Notfallmedizin ist der Nutzen der doppelten Pl\u00e4ttchen-Hemmung bei Patienten mit \u201eST-Hebungsinfarkt\u201c (besser eigentlich okklusiver Myokardinfarkt, OMI) bereits im pr\u00e4hospitalen Bereich. 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