Vorhofflimmern – Innovation, Intervention oder Resignation?

Zusammenfassung

Schlaganfälle sind zu etwa 80% ischämischer und zu etwa 20% hämorrhagischer Ursache. Eine zerebrale Ischämie entsteht am häufigsten durch einen kardioembolischen Verschluss einer Hirnarterie bei Patienten mit Vorhofflimmern (VHF). Durch die Verbreitung der “neuen oralen” oder “nicht Vitamin K abhängigen Antikoagulantien” (NOAK) in der Behandlung des nicht valvulären VHF gerät die Anwendung der Vitamin-K-Antagonisten allmählich in den Hintergrund. Im klinischen Alltag bleiben viele Fragen unbeantwortet. In diesem Artikel soll weniger die Erläuterung der umfangreichen Studienlage zu den NOAK erfolgen, wie anderswo schon vielfach geschehen, sondern vielmehr die praxisorientierte Herangehensweise an die NOAK in Situationen jenseits der Routine.

Summary

Approximately 20% of all strokes are haemorrhagic and 80% are ischaemic. Mostly, a cardiac thrombus is the reason for cerebral ischaemia by embolic occlusion of a cerebral artery in a patient with atrial fibrillation. The “new” or “non vitamin K antagonist oral anticoagulants” (NOAC) have substantially altered the approach to patients with atrial fibrillation and cerebral ischaemia. The direct thrombin-inhibitor Dabigatran and the factor Xa-antagonists Rivaroxaban and Apixaban subsequently replace the routinely applied therapy with vitamin K antagonists. In daily practice, use of NOAC is often challenging, since data form the large randomized studies are limited to a selected patient population. The aim of this article is to discuss practical issues in the management of patients with cerebral ischaemia and atrial fibrillation.

Schlüsselwörter

Zerebrale Ischämie - Schlaganfall - Vorhofflimmern - Antikoagulanzien - NOAC - Nicht-Vitamin-K-Antagonisten - Sekundärprophylaxe

Keywords

Cerebral ischemia - stroke - atrial fibrillation - anticoagulation - non vitamin K antagonist - NOAC - secondary prevention

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