Schlaganfallprävention bei Vorhofflimmern

Zusammenfassung

Die Diagnostik und Therapie des Vorhofflimmerns ist eine besondere klinische Herausforderung und besitzt große Bedeutung für die Primär- und Sekundärprävention des ischämischen Schlaganfalls. In den vergangenen zwei Jahren wurden relevante klinische Studien veröffentlicht, wobei insbesondere die multizentrischen und randomisierten Phase-III-Studien zu dem oral verfügbaren Thrombininhibitor Dabigatran und den Faktor-Xa-Antagonisten Rivaroxaban und Apixaban als Meilensteine anzusehen sind. Diese neuen Antikoagulanzien sind den verfügbaren Vitamin-K-Antagonisten im Hinblick auf die Prävention von Schlaganfällen ebenbürtig bzw. teilweise überlegen. Noch offene Fragen zu den neuen Antikoagulanzien werden diskutiert und erste Empfehlungen für die tägliche Praxis gegeben. Des Weiteren werden relevante Aspekte zur Schlaganfallprävention bei Vorhofflimmern mittels rhythmuserhaltender bzw. nicht medikamentöser Therapieverfahren dargestellt. Neben Studiendaten zu Dronedaron werden die Relevanz der linksatrialen Katheterablation sowie des interventionellen bzw. operativen Vorhofohrverschlusses diskutiert.

Summary

Detection and management of atrial fibrillation remains a challenge in daily clinical practice and is vital for primary and secondary stroke prevention. Over the last two years, several important studies have been published in this regard. Multicenter, randomized phase III trials have compared novel oral anticoagulants to warfarin and demonstrated non-inferiority (or even superiority) of dabigatran (a direct thrombin inhibitor), rivaroxaban and apixaban (both factor Xa antagonists) for stroke prevention. By discussing the current limitations of the novel anticoagulants, we give recommendations for daily clinical practice. Furthermore, we focus on current aspects of rhythm control therapy or non-medical approaches with regard to stroke prevention in atrial fibrillation. Besides data for dronedarone, we discuss the available data on left atrial catheter ablation as well as surgical or interventional left atrial appendage occlusion.

Schlüsselwörter

Antikoagulation - Thrombininhibitoren - Faktor-Xa-Antagonisten - EKG-Diagnostik - Schlaganfallprävention - Vorhofflimmern

Keywords

Anticoagulation - thrombin inhibitor - factor Xa antagonist - ECG-recording - rhythm control therapy

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