Antikoagulation bei Vorhofflimmern

Zusammenfassung

Bei Vorhofflimmern kann effektive Antikoagulation die Gefahr von thrombembolischen Komplikationen, zum Beispiel dem Apoplex, deutlich reduzieren. Hierfür kommen Vitamin- K-Antagonisten (z. B. Phenprocoumon) mit relativ hoher Effektivität, aber auch hohem Blutungsrisiko, oder aber Azetylsalizylsäure (ASS) mit schlechterer Effektivität und geringeren unerwünschten Arzneimittelwirkungen in Frage. Der CHADS2-Score ermöglicht die individuelle Risikoabschätzung und Anpassung der Therapie an das Risiko. In Zukunft könnten neue Substanzen wie Rivaroxaban oder Dabigatran eine effektive und unkomplizierte Antikoagulation ermöglichen.

Summary

In this overview the actual guideline-recommendations for anticoagulation in atrial fibrillation and the problems of the currently available therapy are discussed. Furthermore an outlook over future developments in this field is given. Effective anticoagulation can prohibit thrombembolic events and is thus essential for the prognosis of patients suffering from atrial fibrillation. Until now vitamin-K-antagonists (VKAs) and acetylsalicylic acid (ASA) are available for oral anticoagulation in these patients. VKAs demonstrate a satisfying efficiency combined with rather high bleeding hazard. ASA on the other hand allows only moderate risk reduction with minimal side effects. Thus the guidelines recommend anticoagulation tailored to the individual risk, which can be evaluated by the CHADS2-Score. New therapeutic strategies, like the factor Xa inhibitor rivaroxaban or the factor II inhibitor dabigatran, are actually evaluated in phase III studies. These drugs bear the hope of higher efficiency combined with improved safety and much more comfortable use in the daily practice (e. g. no need for INR measurement, no dose adaptation).

Schlüsselwörter

Vorhofflimmern - Faktor Xa-Inhibition - Thrombin-Inhibition - Vitamin-K-Antagonisten

Keywords

Atrial fibrillation - factor Xa inhibition - thrombin inhibition - vitamin-K-antagonists

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