Vorhofflimmern und Blutungskomplikationen

G. Breithardt; U. Ravens; P. Kirchhof; I. C. van Gelder

doi:10.1055/s-0038-1628223

Nervenheilkunde, Table of Contents

Nervenheilkunde 2012; 31(11): 791-795
DOI: 10.1055/s-0038-1628223

Kompetenzentz Vorhofflimmern

Schattauer GmbH

Vorhofflimmern und Blutungskomplikationen

Risikofaktoren und -markerAtrial fibrillation and bleeding complicationRisk factors and risk marker

G. Breithardt

¹Kompetenznetz Vorhofflimmern (AFNET)

²Department für Kardiologie und Angiologie, Universitätsklinikum Münster

,

U. Ravens

³Institut für Pharmakologie und Toxikologie, Medizinische Fakultät Carl Gustav Carus, Dresden

,

P. Kirchhof

⁴Cardiovascular Medicine, University of Birmingham Centre for Cardiovascular Sciences, Birmingham, England, und Department Kardiologie und Angiologie, Universitätsklinikum Münster

,

I. C. van Gelder

⁵University of Groningen, University Medical Center Groningen, Niederlande

› Author Affiliations

Abstract

Zusammenfassung

Die Entstehung von Vorhofflimmern (VHF) ist eng verbunden mit Risikofaktoren wie Hyper-tonie und Herzinsuffizienz, ferner mit Diabetes mellitus, Herzinfarkt und Herzklappenerkrankungen. Diese Faktoren überlappen teilweise mit denjenigen, die für das Fort-schreiten des VHF und für Schlaganfälle verantwortlich sind. Für die Vorhersage einer Progression von paroxysmalem zu permanentem VHF ist der HATCH-Score (Herzinsuffizienz, Alter, TIA oder Schlaganfall in der Vorgeschichte, chronisch-obstruktive Lungenerkrankung und Hypertonie) vorgeschlagen worden. Der CHADS₂-Score wurde in den Leitlinien der Europäischen Gesellschaft für Kardiologie von 2010 erweitert.

Für die Blutungsbereitschaft spielen teilweise die gleichen Risikofaktoren eine Rolle, die zur Entstehung von VHF führen und das Risiko von Schlaganfällen und TIA bestimmen. Auch wenn die Punktesysteme zur Vorhersage von Ereignissen in größeren Populationen entwickelt worden sind, haben sie zunehmende Bedeutung zur Risikoabschätzung im Einzel-fall erlangt. Auf diese Weise stellen sie eine Hilfe auf dem Weg zu einer besseren Implementierung der oralen Antikoagulation und der Beeinflussung der zum VHF führenden Faktoren in der täglichen Praxis dar.

Summary

The development of atrial fibrillation (AF) is closely linked to risk factors like hypertension and heart failure, diabetes mellitus, myocardial infarction and valvular heart disease. These factors partly overlap with those which determine the progression of atrial fibrillation and the incidence of stroke. For prediction of progression of atrial fibrillation from paroxysmal to permanent AF, the HATCH score (heart failure, age, previous TIA or stroke, chronic obstructive pulmonary disease and hypertension) has been proposed. The CHADS_{2 s}core for prediction of stroke has been expanded in the recent guidelines of the European Society of Cardiology by additional factors.

The bleeding risk is partly related to the same risk factors that determine the development of AF and the risk of stroke and TIA. Although these and other score systems have been developed for the prediction of events in larger populations, and thus have some limitations when applied to the individual patient, they have increasingly been used in clinical practice. They help to achieve a better implementation of oral anticoagulation and of preventive measures to influence the development and progression of AF.

Schlüsselwörter

Vorhofflimmern - Prävalenz - Risikofaktoren - Risikomarker - Komplikationen - Schlaganfall - Embolie

Keywords

Atrial fibrillation - prevalence - risk factors - risk markers - complications - stroke - embolism.

Full Text

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