Antithrombotic management in patients with atrial fibrillation

作者：Schumacher B^*; Langbein A

来源：Nervenheilkunde, 2012, 31(4): 250-255.

• Atrial fibrillation
• stroke
• warfarin
• dabigatran
• apixaban
• watchman device

In this review article, the current recommendations for prevention of thromboembolic complications in patients with atrial fibrillation are summarized and discussed. Preventive strategies of thromboembolic complications depend, on the individual risk of the patient, e. g. stratified with the CHA(2)DS(2)-VASc score and the HAS-BLED score. If oral anticoagulation is adequate, vitamin K antagonists are the backbone of therapy. Vitamin K antagonists result in a relative risk reduction of 65 to 70% for ischemic strokes. However, the annual risk for major bleeding events exceeds 1% in most studies. In this context, novel oral direct thrombin or factor Xa antagonists (e. g. dabigatran, rivaroxaban, apixaban, edoxaban) are highly anticipated since the risk/benefit ratio presumably is superior to that of vitamin K antagonists. Recent data support this (RELY trial, Rocket-AF trial, ARISTOTLE trial). In the ARISTOTLE trial, apixaban compared to warfarin resulted in a relative risk reduction of 21% for the composite end-point (ischemic strokes, hemorrhagic strokes, systemic embolic events), a relative risk reduction of 31% for major bleeding events, and a relative risk reduction of almost 50% for hemorrhagic strokes. In patients not eligible for oral anticoagulation due to an excessive bleeding risk, transvenous left atrial appendage occlusion is an alternative treatment option. ASS has no proven effect in patients with atrial fibrillation and is not recommended anymore.

• 出版日期2012