Besonderheiten der Antikoagulation bei Vorhofflimmern: Tripeltherapie und perioperatives Bridging

Zusammenfassung

Vorhofflimmerpatienten haben zum Großteil eine Indikation zur Vollantikoagulation. Praktische Probleme ergeben sich, wenn zusätzlich die Indikation für eine Plättchen-hemmende Therapie im Rahmen einer Koronarintervention, die sog. Tripeltherapie besteht, oder aber auch wie man sich mit der Antikoagulation bei Operationen verhält. Die Studienlage für beide Fragen ist relativ gering. Im Prinzip ist in beiden Fällen ein individualisiertes Vorgehen anzustreben, das auf der einen Seite das Blutungs-, auf der anderen Seite das thrombembolische Risiko berücksichtigt. Im vorliegenden Artikel werden hierzu pragmatische Handlungsempfehlungen gegeben unter Berücksichtigung der aktuellen Studienlage.

Abstract

Patients with atrial fibrillation have in large parts an indication for full anticoagulation. Practical problems develop when there is an additional indication for a platelet inhibitory treatment, so called triple therapy, in case of percutaneous coronary intervention or how to manage anticoagulation in case of an operation. Clinical studies are relatively limited. Essentially, an individualized approach is necessary taking into account the bleeding on the one and the thromboembolic risk on the other side. In this review we a give a pragmatic treatment approach with discussion of the recent literature.

Schlüsselwörter

Vorhofflimmern - Koronare Herzerkrankung - Bridging, Operation

Keywords

atrial fibrillation - coronary artery disease - bridging, operation

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