Nur noch selten ohne Antikoagulation – Aktuelle Diagnostik und Therapie bei Vorhofflimmern und Schlaganfall

Vorhofflimmern (VHF) ist die häufigste Ursache kardial-embolischer Hirninfarkte und wahrscheinlich auch für einen erheblichen Anteil der bisher als kryptogen bewerteten Hirninfarkte verantwortlich. Methoden zur besseren Detektion und Therapie von paroxysmalem VHF bei Schlaganfall oder transienten ischämischen Attacken (TIA) werden derzeit untersucht.

Die orale Antikoagulation (OAK) mit Warfarin und neueren Substanzen ist hochwirksam in der Prophylaxe embolischer Hirninfarkte. Nur ein geringer Anteil der Patienten mit VHF hat ein niedriges Schlaganfallrisiko und kann auf eine OAK verzichten. Zur Beurteilung des individuellen Risikos sollte der CHA₂DS₂-VASc-Score verwendet werden. Intrakranielle Blutungen sind die gefährlichste Nebenwirkung der OAK.

Atrial fibrillation (AF) is the main cause of cardiogenic stroke and probably also responsible for a considerable proportion of cryptogenic strokes. Methods for better detection and treatment of paroxysmal AF in stroke or TIA patients are under investigation.

Oral anticoagulation with warfarin and newer substances is highly effective in the prevention of embolic strokes. Only a small minority of AF patients is truly at low risk and can be treated without oral anticoagulation (OAC). The individual risk should be rated using the CHA₂DS₂-VASc-score. Intracranial bleeding is the most dangerous risk of OAC.

Key words

atrial fibrillation - stroke - anticoagulation - intracranial bleeding

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