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Dtsch Med Wochenschr 2000; 125(42): 1267-1271
DOI: 10.1055/s-2000-7855
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© Georg Thieme Verlag Stuttgart · New York

Antikoagulation bei Vorhofflimmern

C. Burkhard-Meier1 , H. J. Deutsch2 , E. Erdmann3
  • 1Herzkreislauf-Klinik Bad Berleburg (Direktoren: Dr. C. Halhuber, Prof. Dr. B. Noll)
  • 2Sankt Katharinen Hospital Frechen, Innere Abteilung Kardiologie (Chefarzt: Prof. Dr. H.J. Deutsch)
  • 3Medizinische Klinik III für Innere Medizin (Direktor: Prof. Dr. E. Erdmann), Universität zu Köln
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Publication History

Publication Date:
31 December 2000 (online)

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Zusammenfassung

Die absolute Arrhythmie (AF) bei Vorhofflimmern ist eine häufige Herzrhythmusstörung. Bei Patienten mit valvulärem (rheumatischem) Vorhofflimmern ist die orale Antikoagulation (OAC) als Thrombembolieprophylaxe etabliert. Nun belegen kontrollierte Studien den Wert einer OAC auch bei nichtvalvulärem Vorhofflimmern und Thrombembolie-Risikofaktoren. Zu den »hig risk«-Faktoren zählen z. B. arterielle Hypertonie RR syst. > 160 mmHg, Z.n. TIA/Apoplex, Frauen > 75 Jahre, reduzierte LV-Funktion. Vor der Entscheidung einer OAC oder einer Antiaggregation z. B. mit Acetylsalicylsäure (ASS), hat die Abschätzung des individuellen Thrombembolie-Risikos zu stehen (Risiko-Stratifizierung). Patienten mit »high risk«-Faktoren müssen antikoaguliert werden. Dabei ist ein höheres Lebensalter (< 80 Jahre) keine Kontraindikation gegen OAC. Allerdings ist bei Patienten > 80 Jahren mit Nebenerkrankungen angesichts einer erhöhten Blutungsrate unter OAC eher eine ASS-Medikation zu empfehlen. Patienten < 65 Jahre ohne klinische oder echokardiographische Risikofaktoren (reduzierte LV-Funktion FS < 25 %) können mit ASS 325 mg/Tag behandelt werden. Bei Patienten zwischen 65 und 80 Jahren ohne Risikofaktoren muss im Einzelfall entschieden werden. Mittels vorherigher TEE-Abklärung kann sich eine Kardioversion sicher durchführen und die Antikoagulationsdauer verkürzen lassen.

Atrial Fibrillation and Anticoagulation

Atrial fibrillation (AF) is a common rhythm disturbance and a major risk factor for stroke. Oral anticoagulation (OAC) is well established in rheumatic valvular AF. Various randomized trials strongly support the use of OAC for the prevention of thrombembolism in patients with nonvalvular atrial fibrillation. Using several clinical and echocardiographical features the individual risk of the patient for embolic events has to be determined before treatment (risk stratification). In high risk patients oral anticoagulation is recommended. Advanced age (< 80 years) is not a contraindication to anticoagulant therapy. But in the very elderly (> 80 years) with a great comorbidity aspirin is preferable (increased risk of major bleedings under OAC). Aspirin is recommended in patients > 65 years without clinical or echocardiographical risk factors (fractional shortening < 25 %) and in patients with contraindications against OAC. In patients aged 65-80 years without other risk factors treatment has to be decided on individual cases. The TEE-guided approach before cardioversion is feasible and safe and may help to reduce the duration of anticoagulation before cardioversion.

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Korrespondenz

Dr. Caspar Burkhard-Meier

Herz-Kreislauf-Klinik

Arnikaweg

57319 Bad Berleburg

Phone: 02751/88-0

Fax: 02751/88-2407

Email: caspmei@aol.com