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Antikoagulation — Indikation, Durchführung, klinische Ergebnisse

  • Conference paper
Vorhofflimmern Vorhofflattern

  • 33 Accesses

Zusammenfassung

Neben der antiarrhythmischen Therapie bei Vorhofflimmern kommt der Antikoagulation eine wichtige Bedeutung zu. Denn Morbidität und Mortalität bei Vorhofflimmern werden entscheidend durch die embolischen Komplikationen bestimmt: das Risiko von Thromboembolien ist bei nichtrheumatisch bedingtem Vorhofflimmern 5,6fach, bei Vorhofflimmern auf dem Boden eines rheumatischen Herzklappenfehlers gar 17,6fach erhöht [19]. Als pathophysiologischer Faktor scheint neben der Stase im linken Vorhof, hervorgerufen durch eine herabgesetzte Vorhofkontraktilität, auch eine Hyperkoagulabilität eine Rolle zu spielen [17]. Etwa 75% aller Thromboembolien betreffen zudem das zerebrale Stromgebiet. Daher ist verständlich, daß 6–24% aller ischämischen Insulte auf eine kardiale Embolie bei Vorhofflimmern zurückgeführt werden [8]. Mehrere epidemiologische Analysen und großangelegte Studien haben in den letzten Jahren zum besseren Verständnis der Risikofaktoren für embolische Komplikationen geführt und den Stellenwert der Antikoagulation bei Vorhofflimmern untersucht. Dabei muß zwischen der chronischen Embolieprophylaxe und der Antikoagulation vor und nach Kardioversion unterschieden werden.

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Literatur

  1. Arnold AZ, Mick MJ, Mazurek RP, Loop FD, Trohmann RG (1992) Role of prophylactic anticoagulation for direct cardioversion in patients with atrial fibrillation and flutter. J Am Coll Cardiol 19:851–855.

    Article  PubMed  CAS  Google Scholar 

  2. Atrial Fibrillation Investigators (1994) Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Arch Intern Med 154:1449–1457.

    Article  Google Scholar 

  3. Benjamin EJ, Wolf PA, D’Agostino RB, Silbershatz H, Kannel WB, Levy D (1998) Impact of atrial fibrillation on the risk of death. The Framingham Heart Study. Circulation 98:946–952.

    Article  PubMed  CAS  Google Scholar 

  4. Bjerkelund C, Orning OM (1969) The efficacy of anticoagulant therapy in preventing embolism related to DC. Am J Cardiol 23:208–216.

    Article  PubMed  CAS  Google Scholar 

  5. Black IW, Fatkin D, Sagar KB, Khanderia BK, Leung DY, Galloway JM, Feneley MP, Walsh WF, Grimm RA, Stollberger C, Verhorst OMJ, Klein AL (1994) Exclusion of atrial thrombus by transesophageal echocardiography does not preclude embolism after cardioversion of atrial fibrillation. Circulation 89:2509–2513.

    Article  PubMed  CAS  Google Scholar 

  6. Blackshear JL, Pearce LA, Asinger RW, Dittrich HC, Goldmann ME, Zabalgoittia M, Rothbart RM, Halperin JL (1993) Stroke Prevention in Atrial Fibrillation Investigators. Mitral regugitation associated with reduced thromboembolic events in high-risk patients with nonrheumatic atrial fibrillation. Am J Cardiol 72:840–843.

    Article  PubMed  CAS  Google Scholar 

  7. Carlson J, Tebbe U, Rox J Harmjanz D, Haerten K, Neuhaus KL, Seidel F, Niederer W, Miketic S, for the ALKK Study Group (1996) Cardioversion of atrial fibrillation in the elderly. Am J Cardiol 78:1380–1384.

    Article  Google Scholar 

  8. Cerebral Embolism Task Force (1989) Cardiogenic brain embolism. The second report of the Cerebral Embolism Task Force. Arch Neurol 46:727–743.

    Article  Google Scholar 

  9. Chalasani P, Chambre S, Silvermann ME (1992) Direct-current cardioversion for the conversion of atrial flutter. J Am Coll Cardiol 24:159–164.

    Google Scholar 

  10. Connolly SJ, Laupacis A, Gent M, Roberts RS, Cairns JA, Joyner C for the CAFA study coinvestigators (1991) Canadian Atrial Fibrillation Anticoagulation (CAFA) Study. J Am Coll Cardiol 18:349–355.

    Article  PubMed  CAS  Google Scholar 

  11. European Atrial Fibrillation Trial Study Group (1993) Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. Lancet 342:1255–1262.

    Google Scholar 

  12. Ezekowitz MD, Bridgers SL, James KE et al. (1992) Stroke Prevention in Atrial Fibrillation Study: final results. N Engl J Med 327:1406–1412.

    Article  PubMed  CAS  Google Scholar 

  13. Fatkin D, Kuchar DL, Thorburn CW, Feneley MP (1994) Transoesophageal echocardiography before and during direct current cardioversion of atrial fibrillation: evidence for „atrial stunning“ as a mechanism of thromboembolic complications. J Am Coll Cardiol 23:307–316.

    Article  PubMed  CAS  Google Scholar 

  14. Grimm RA, Leung DY, Black IW, Stewart WJ, Thomas JD, Klein AL (1995) Left atrial appendage „stunning“ after spontaneous cardioversion of atrial fibrillation demonstrated by transoesophageal Doppler Echocardiography. Am Heart J 130:174–176.

    Article  PubMed  CAS  Google Scholar 

  15. Grimm RA, Stewart WJ, Maloney JD, Cohen GI, Pearce GL, Salcedo EE, Klein AL (1993) Impact of electrical cardioversion of atrial fibrillation on left atrial appendage function and spontaneous echo contrast: characterization by simultaneous transoesophageal echocardiography. J Am Coll Cardiol 22:1359–1366.

    Article  PubMed  CAS  Google Scholar 

  16. Harjari KJ, Mobarek SK, Cheirif J, Boulos LM, Murgo JP, Abi-Samra F (1997) Clinical variables affecting recovery of left atrial mechanical function after cardioversion from atrial fibrillation. J Am Coll Cardiol 30:481–486.

    Article  Google Scholar 

  17. Heppell RM, Berkin KE, McLenachan JM, Davies JA (1997) Hemostatic and hemodynamic abnormalities associated with left atrial thrombosis in non-rheumatic atrial fibrillation. Heart 77:407–411.

    PubMed  CAS  Google Scholar 

  18. Irani WN, Grayburn PA, Afridi I (1997) Prevalence of thrombus, spontaneous echo contrast and atrial stunning in patients undergoing cardioversion of atrial flutter: a prospective study using transoesophageal echocardiography. Circulation 95:962–966.

    Article  PubMed  CAS  Google Scholar 

  19. Kannel WB, Abbot RD, Savage DD, McNamara PM (1982) Epidemiologic features of chronic atrial fibrillation; the Framingham study. N Engl J Med 306:1018–1022.

    Article  PubMed  CAS  Google Scholar 

  20. Klein AL, Grimm RA, Black IW, Leung DY, Chung MK, Vaughn SE, Murray D, Miller DP, Arheart KL, for the ACUTE: Investigators (1997) Cardioversion guided by transoesophageal echocardiography: the ACUTE pilote study: a randomized, controlled trial. Ann Intern Med 126:200–209.

    PubMed  CAS  Google Scholar 

  21. Laupacis A, Albers G, Dunn M et al (1992) Antithrombotic therapy in atrial fibrillation. 3d ACCP Conference on Antithrombotic therapy. Chest 102:S426–S433 (suppl.).

    Article  Google Scholar 

  22. Levy S, Breithardt G, Campbell RWF, Camm AJ, Daubert JC, Allessie M, Aliot E, Capucci A, Cosio F, Crijns H, Jordaens L, Hauer RNW, Lombardi F, Lüderitz B on behalf of the Working Group on Arrhythmias of the European Society of Cardiology (1998) Atrial fibrillation: current knowledge and recommendations for management. Eur Heart J 19:1294–1320.

    Article  PubMed  CAS  Google Scholar 

  23. Lip GYH, Yyen Tean K, Dunn FG (1994) Treatment of atrial fibrillation in a district general hospital. Br Heart J 71:92–95.

    Article  PubMed  CAS  Google Scholar 

  24. Manning WJ, Weintraub RM, Waksmonski CA, Haering JM, Rooney PS. Maslow AD, Johnson RG, Douglas PS (1995) Accuracy of transoesophageal echocardiography for identifying left atrial thrombi: a prospective intraoperative study. Ann Intern Med 123:817–822.

    PubMed  CAS  Google Scholar 

  25. Manning WJ, Silvermann DI, Katz SE, Riley MF, Come PC, Doherty RM, Munson JT, Douglas PS. Impaired left atrial function after cardioversion: relationship to the duration of atrial fibrillation (1994) J Am Coll Cardiol 23:1535–1540.

    Article  PubMed  CAS  Google Scholar 

  26. Manning WJ, Silvermann DI, Gordon SPF, Krummholz HM, Douglas PS (1993) Cardioversion from atrial fibrillation without prolonged anticoagulation with the use of transoesophageal echocardiography to exclude the presence of atrial thrombi. N Engl J Med 328:750–755.

    Article  PubMed  CAS  Google Scholar 

  27. Morocutti C, Amabile G, Fattaposta F, Nicolosi A, Matteoli S, Trappolini M, Cataldo G, Milanesi G, Lavezzari M, Pamparana F, Coccheri S, for the SIFA Investigators (1997) Indobufen versus warfarin in the secondary prevention of major vascular events in nonrheumatic atrial fibrillation. Circulation 28:1015–1021.

    CAS  Google Scholar 

  28. Mügge A, Daniel WG, Hausmann D, Godke J, Wagenbreth I, Lichtlen PR (1990) Diagnosis of left atrial appendage thrombi by transoesophageal echocardiographie: clinical implications and follow-up. Am J Card Imaging 4:173–179.

    Google Scholar 

  29. Petersen P, Boysen G, Godtfredsen J, Andersen ED, Andersen B (1989) Placebocontrolled, randomized trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation: the Copenhagen AFASAK Study. Lancet 1:175–179.

    Article  PubMed  CAS  Google Scholar 

  30. Prystowsky EN, Benson W jr, Fuster V, Hart RG, Kay GN, Myerburg RJ, Naccarelli GV, Wyse G (1996) Management of patients with atrial fibrillation. A statement for healthcare professionals from the Subcommittee on Electrocardiography and Electrophysiology, American Heart Association. Circulation 93:1262–1277.

    Article  PubMed  CAS  Google Scholar 

  31. Schlicht JR, Davis RC, Naqi K, Cooper W, Rao BV (1996) Physician practices regarding anticoagulation and cardioversion of atrial fibrillation. Arch Intern Med 156;290–294.

    Article  PubMed  CAS  Google Scholar 

  32. Silvermann DI, Manning WJ(1998) Role of echocardiography in patients undergoing elective cardioversion of atrial fibrillation. Circulation 98:479–486.

    Article  Google Scholar 

  33. Stoddard MF, Dawkins P, Prince CR, Longaker RA (1991) Transoesophageal echocardiographic guidance of cardioversion in patients with atrial fibrillation. Circulation 83:817–821.

    Article  Google Scholar 

  34. Stroke Prevention in Atrial Fibrillation Investigators (1996) Adjusted-dose warfarin versus low-intensity, fixed-dose warfarin plus aspirin for high-risk patients with atrial fibrillation: Stroke Prevention in Atrial Fibrillation III randomized clinical trial. Lancet 348:633–638.

    Article  Google Scholar 

  35. Stroke Prevention in Atrial Fibrillation Investigators: Warfarin versus aspirin for prevention of thromboembolism in atrial fibrillation (1994) Stroke Prevention in Atrial Fibrillation II Study. Lancet 343:687–691.

    Google Scholar 

  36. Stroke Prevention in Atrial Fibrillation investigators (1992) Predictors of thromboembolism in atrial fibrillation II: echocardiographic features of patient at risk. Ann Intern Med 116:6–12.

    Google Scholar 

  37. Stroke Prevention in Atrial Fibrillation Investigators (1991) Stroke Prevention in Atrial Fibrillation Study: final results. Circulation 84:527–539.

    Article  Google Scholar 

  38. The Boston Area Anticoagulation Trial for Atrial Fibrillation Investigators (1990) The effect of low-dose warfarin on the risk of stroke in patients with nonrheumatic atrial fibrillation. New Engl J Med 323:1505–1511.

    Article  Google Scholar 

  39. Weinberg DM, Mancini GBJ (1989) Anticoagulation for cardioversion in atrial fibrillation. Am J Cardiol 63:745–746.

    Article  PubMed  CAS  Google Scholar 

  40. Wijfels MC, Kirchhof CJHJ, Dorland R, Allessie MA (1995) Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats. Circulation 92:1954–1968.

    Article  Google Scholar 

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Authors
  1. C. Stellbrink
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  2. M. Zarse
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Editors and Affiliations

  1. Abt. für Kardiologie, Kerckhoff-Klinik, Benekestraße 2-8, 61231, Bad Nauheim, Deutschland

    Jörg Neuzner  & Heinz F. Pitschner  & 

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© 2000 Springer-Verlag Berlin Heidelberg

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Stellbrink, C., Zarse, M. (2000). Antikoagulation — Indikation, Durchführung, klinische Ergebnisse. In: Neuzner, J., Pitschner, H.F. (eds) Vorhofflimmern Vorhofflattern. Steinkopff, Heidelberg. https://doi.org/10.1007/978-3-662-13383-5_7

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  • DOI: https://doi.org/10.1007/978-3-662-13383-5_7

  • Publisher Name: Steinkopff, Heidelberg

  • Print ISBN: 978-3-662-13384-2

  • Online ISBN: 978-3-662-13383-5

  • eBook Packages: Springer Book Archive

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