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Dtsch Med Wochenschr 2006; 131(13): 681-684
DOI: 10.1055/s-2006-933716
Aktuelle Diagnostik & Therapie
Kardiologie
© Georg Thieme Verlag Stuttgart · New York

Langzeit-Antikoagulation bei Patienten mit Vorhofflimmern

Long-term anticoagulation in patients with atrial fibrillationA. Schuchert1
  • 1Universitäres Herzzentrum Hamburg
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Publication History

eingereicht: 17.10.2005

akzeptiert: 9.2.2006

Publication Date:
23 March 2006 (online)

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Vorhofflimmern (VHF) ist die häufigste anhaltende atriale Rhythmusstörung. Mit einer Häufigkeit von unter 1 % in der Allgemeinbevölkerung bis 55 Jahre, von 4-6 % bei über 60-Jährigen und von 9-16 % bei über 80-Jährigen steigt die Häufigkeit mit dem Lebensalter an [10]. Eine relevante Komplikation des VHF ist im Vergleich zu Patienten im Sinusrhythmus das häufigere Auftreten arterieller Thromboembolien, die sich in ca. 90 % als ischämische zerebrale Insulte manifestieren. Das individuelle Risiko für einen Schlaganfall schwankt erheblich, wobei wesentliche Risikofaktoren ein höheres Lebensalter und (kardiale) Begleiterkrankungen sind.

Literatur

  • 1 Adjusted-dose warfarin versus low-intensity, fixed-dose warfarin plus Aspirin for high-risk patients with atrial fibrillation: Stroke Prevention in Atrial Fibrillation III randomised clinical trial.  Lancet. 1996;  348 633-638
    Google Scholar
  • 2 Albers G W, Diener H C, Frison L. et al. SPORTIF Executive Steering Committee for the SPORTIF V Investigators (2005) . Ximelagatran vs warfarin for stroke prevention in patients with nonvalvular atrial fibrillation: a randomized trial.  JAMA. 293 690-698
    Google Scholar
  • 3 Atrial F ibrillation Investigators. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation: analysis of pooled data from five randomized controlled trials.  Arch Intern Med. 1994;  154 1449-1457
    Google Scholar
  • 4 Atrial Fibrillation Investigators . Echocardiographic predictors of stroke in patients with atrial fibrillation: a prospective study of 1,066 patients from three clinical trials.  Arch Intern Med. 1998;  158 1316-1320
    Google Scholar
  • 5 Boston Area Anticoagulation Trial for Atrial Fibrillation Investigators . The effect of low-dose warfarin on the risk of stroke in patients with nonrheumatic atrial fibrillation.  N Engl J Med. 1990;  323 1505-1511
    Google Scholar
  • 6 EAFT (European Atrial Fibrillation Trial) Study Group . Secondary prevention in non-rheumatic atrial fibrillation after transient ischemic attack or minor stroke.  Lancet. 1993;  342 1255-1262
    Google Scholar
  • 7 Ezekowitz M D, Bridgers S L, James K E. et al . Warfarin in the prevention of stroke associated with nonrheumatic atrial fibrillation: Veterans Affairs Stroke Prevention in Nonrheumatic Atrial Fibrillation Investigators.  N Engl J Med. 1992;  327 1406-1412
    Google Scholar
  • 8 Fihn S D, Callahan C M, Martin D C. et al, for the National Consortium of Anticoagulation Clinics . The risk for and severity of bleeding complications in elderly patients treated with warfarin.  Ann Intern Med. 1996;  124 970-979
    Google Scholar
  • 9 Fuster V, Ryden L E. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation.  JACC. 2001;  38 1231-1266
    Google Scholar
  • 10 Go A S, Hylek E M, Phillips K A. et al . Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study.  JAMA. 2001;  285 2370-2375
    Google Scholar
  • 11 Go A S, Hylek E M, Chang Y. et al . Anticoagulation therapy for stroke prevention in atrial fibrillation: how well do randomized trials translate into clinical practice?.  JAMA. 2003;  290 2685-2692
    Google Scholar
  • 12 Gullov A L, Koefoed B G, Petersen P. et al . Fixed minidose warfarin and Aspirin alone and in combination versus adjusted-dose warfarin for stroke prevention in atrial fibrillation: Second Copenhagen Atrial Fibrillation, Aspirin, and Anticoagulation Study (the AFASAK-2 study).  Arch Intern Med. 1998;  158 1513-1521
    Google Scholar
  • 13 Hart R G, Benavente O, McBride R. et al . Antithrombotic therapy to prevent stroke in patients with atrial fibrillation: a meta-analysis.  Ann Intern Med. 1999;  131 492-501
    Google Scholar
  • 14 Hart R G, Pearce L A, McBride R. et al . Factors associated with ischemic stroke during Aspirin therapy in atrial fibrillation: analysis of 2012 participants in the SPAF I-III clinical trials: Stroke Prevention in Atrial Fibrillation (SPAF) Investigators.  Stroke. 1999;  30 1223-1229
    Google Scholar
  • 15 Hellemons B SP, Lanbenberg M, Lodder J. et al . Primary prevention of arterial thromboembolism in non-rheumatic atrial fibrillation in primary care: randomised controlled trial comparing two intensities of coumarin with Aspirin.  BMJ. 1999;  319 958-964
    Google Scholar
  • 16 Hylek E M, Skates S J, Sheehan M A. et al . An analysis of the lowest effective intensity of prophylactic anticoagulation for patients with nonrheumatic atrial fibrillation.  N Engl J Med. 1996;  335 540-546
    Google Scholar
  • 17 Hylek E M, Go A S, Chang Y. et al . Effect of intensity of oral anticoagulation on stroke severity and mortality in atrial fibrillation.  N Engl J Med. 2003;  349 1019-1026
    Google Scholar
  • 18 Lewalter T, Luderitz B. Vorhofflimmern - interventionelle Differenzialtherapie unter besonderer Berücksichtigung des Lebensalters.  Dtsch Med Wochenschr. 2005;  130 721-725
    Google Scholar
  • 19 Menendez-Jandula B, Souto J C, Oliver A. et al . Comparing Self-Management of Oral Anticoagulant Therapy with Clinic Management.  Ann Intern Med. 2005;  142 1-10
    Google Scholar
  • 20 Patten M, Meinertz T. Medikamentöse antiarrhythmische Therapie - aktuelle Aspekte.  Dtsch Med Wochenschr. 2005;  130 1325-1329
    Google Scholar
  • 21 Petersen P, Boysen G, Godtfredsen J. et al . Placebo-controlled, randomised trial of warfarin and Aspirin for prevention of thromboembolic complications in chronic atrial fibrillation: the Copenhagen AFASAK study.  Lancet. 1989;  1 175-178
    Google Scholar
  • 22 Rockson S G, Albers G W. Comparing the guidelines: anticoagulation therapy to optimize stroke prevention in patients with atrial fibrillation.  J Am Coll Cardiol. 2004;  43 929-935
    Google Scholar
  • 23 Singer D E, Albers G W, Dalen J E. et al . Antithrombotic therapy in atrial fibrillation: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.  Chest. 2004;  126 (Suppl 3) 429S-456S
    Google Scholar
  • 24 SPAF III Writing Committee for the Stroke Prevention in Atrial Fibrillation Investigators . Patients with nonvalvular atrial fibrillation at low risk of stroke during treatment with Aspirin: Stroke Prevention in Atrial Fibrillation III study.  JAMA. 1998;  279 1273-1277
    Google Scholar
  • 25 Stellbrink C, Nixdorff U, Hofmann T. et al . ACE (Anticoagulation in Cardioversion using Enoxaparin) Study Group Safety and efficacy of enoxaparin compared with unfractionated heparin and oral anticoagulants for prevention of thromboembolic complications in cardioversion of nonvalvular atrial fibrillation: the Anticoagulation in Cardioversion using Enoxaparin (ACE) trial.  Circulation. 2004;  109 997-1003
    Google Scholar
  • 26 Stroke Prevention in Atrial Fibrillation Investigators . Warfarin versus Aspirin for prevention of thromboembolism in atrial fibrillation: Stroke Prevention in Atrial Fibrillation II Study.  Lancet. 1994;  343 687-691
    Google Scholar
  • 27 Stroke Prevention in Atrial Fibrillation Investigators . Risk factors for thromboembolism during Aspirin therapy in patients with atrial fibrillation: the Stroke Prevention in Atrial Defibrillation Study.  J Stroke Cerebrovasc Dis. 1995;  5 147-157
    Google Scholar
  • 28 Völler H, Glatz J, Taborski U. et al . Self-Management of oral Anticoagulation in nonvalvular Atrial Fibrillation (SMAAF study).  Z Kardiol. 2005;  94 182-186
    Google Scholar
  • 29 Voss R, Grebe M. Perioperative/peri-interventionelle Antikoagulation.  Dtsch Med Wochenschr. 2005;  130 2209-2212
    Google Scholar
  • 30 van Walraven C, Hart R G, Wells G A. et al . A clinical prediction rule to identify patients with atrial fibrillation and a low risk for stroke while taking aspirin.  Arch Intern Med. 2003;  163 936-943
    Google Scholar
  • 31 Gang B F, Waterman A D, Shannon W, Boechler M, Rich M W, Radford M J. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation.  JAMA. 2001;  285 (22) 2864-2870
    Google Scholar
  • 32 Wang T J, Massaro J M, Levy D, Vasan R S, Wolf P A, D’Agostino R B, Larson M G, Kannel W B, Benjamin E J. A risk score for predicting stroke or death in individuals with new-onset atrial fibrillation in the community: the Framingham Heart Study.   JAMA. 2003;  290 (8) 1049-1056
    Google Scholar

Prof. Dr. A. Schuchert

Universitäres Herzzentrum Hamburg, Klinik und Poliklinik für Kardiolgie und Angiologie

Martinistraße 52

20246 Hamburg

Phone: 0049/40/428035304

Fax: 0049/40/428034125

Email: schuchert@uke.uni-hamburg.de

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