Platelet Aggregation Inhibitors

DOI: 10.3238/zfa.2020.0170-0175

german translation / full article

Günther Egidi

Keywords: clopidogrel double platelet therapy prasugrel ticagrelor triple therapy

BackgroundWith increasing number of available platelet inhibitors, the insecurity of family physicians has increased as to which substance to prefer. At the same time, there is often concern about possible bleeding complications. And the significantly higher prices of the new substances give rise to fears of straining the family doctor‘s medication budget.Search methodSystematic research in Medline and Cochrane on the duration of double platelet inhibition after drug-eluting stents and after stroke, on prasugrel, ticagrelor, triple therapy with vitamin K antagonists or NOAK and on platelet function tests. The result of the update of the DEGAM-S2e guideline is presented.Main messagesFirst, a distinction should be made between stable CHD and acute coronary syndrome. For stable CHD, double platelet inhibition is sufficient for three to six months. In acute coronary syndrome, Ticagrelor should be given for one year in addition to aspirin. After stroke, clopidogrel should be added to aspirin for three weeks. Patients with concomitant anticoagulation should be given triple therapy with phenprocoumon, aspirin and clopidogrel for six months, and only clopidogrel and phenprocoumon from month six to twelwe, followed by phenprocoumon alone. After coated stents, the duration of triple therapy can be reduced to one to six months, depending on the stent coating, with stable CHD. NOAKs are not recommended, nor are platelet function tests.ConclusionsA disease and stent-coating differential approach helps to reduce bleeding complications. The concentration on a few recommended substances makes the situation clearer for family doctors and helps to save the budget.Keywordsclopidogrel; double platelet therapy; ticagrelor; prasugrel; triple therapy

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