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DOI: 10.1055/s-2007-982778
© Georg Thieme Verlag Stuttgart · New York
Antikoagulation bei Patienten mit Vorhofflimmern - Sorgfältige Risikoabschätzung schützt vor Schlaganfall
Anticoagulation in patients with atrial fibrillation - careful risk stratification protects against strokePublication History
Publication Date:
29 May 2007 (online)

Die absolute Arrhythmie bei Vorhofflimmern ist mit zunehmendem Alter die häufigste Rhythmusstörung. Patienten sind ohne eine effektive Thrombembolieprohylaxe erheblich schlaganfallgefährdet. Bei permanentem Vorhofflimmern kommt der sorgfältigen Risikoabschätzung für die Entscheidung zwischen oraler Antikoagulation und Thrombozytenaggregationshemmung eine große Bedeutung zu. Bei geringem Risiko kann die Behandlung mit ASS ausreichend sein, in allen anderen Fällen ist die Antikoagulation durch ein Cumarin-Derivat INR-adaptiert Therapie der ersten Wahl. Für eine Arrhythmiedauer von weniger als 48 Stunden ist keine Thrombembolieprohylaxe - auch bei Kardioversion - notwendig. Drei Wochen vor und bis mindestens vier Wochen (besser sechs Monate) nach einer Kardioversion sollte eine orale Antikoagulation mit einem INR zwischen 2,0 und 3,0 durchgeführt werden.
Atrial fibrillation is the most common arrhythmia. Patients without effective anticoagulation or platelet-inhibiting therapy are at increasing risk for thromboembolism with age, especially stroke. In order to decide wether to put someone on warfarin or aspirin careful risk stratification is essential. In persistent atrial fibrillation without any major risk factors, aspirin (81-325 mg) might be sufficient to prevent thrombembolic events, in all other cases dose adjusted anticoagulation (INR 2,0 to 3,0) is strongly recommended. For arrhythmic periods lasting less than 48 hours no anticoagulation, not even for cardioversion, is needed. If cardioversion is planned, adequate warfarin therapy (INR 2,0 to 3,0) should be maintained from three weeks before to least four weeks, six months respectively, after establishing sinus rhythm.
Key words
atrial fibrillation - arrhythmia - thromboembolism - anticoagulation - risk stratification
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