Anticoagulation in atrial fibrillation

Herz - Atrial fibrillation (AF) is the most frequently encountered sustained arrhythmia with a prevalence of 0.5–10%, depending predominantly on age. The arrhythmia is associated...     

Anticoagulation in atrial fibrillation

Thromboembolic complications are a major problem in patients with atrial fibrillation. This vignette presents the probabilities of thromboembolism in the various etiologies of atrial fibrillation and prophylactic management with anticoagulants.     

Anticoagulation for atrial fibrillation

For over two decades, valuable insights have been accumulated from epidemiologic studies and randomized trials about the risks for and prevention of AF-related stroke. AF substantially raises the risk of stroke, most likely through an atrio-embolic mechanism. Warfarin and other members of its class of oral anticoagulants targeted at an INR of 2.5 can abrogate the risk of stroke attributable to AF effectively and fairly safely. High-quality management of anticoagulation can be achieved in usual clinical care. These insights have important implications for the care of individual patients and more generally for public health. Future research is needed to specify the risk of stroke and hemorrhage among patients with AF better, particularly among older individuals, to optimize use of antithrombotic agents, and to define the role of recently developed antithrombotic drugs and invasive nondrug approaches.     

非瓣膜病性心房颤动的抗栓治疗

心房颤动（房颤）是最常见的持续性心律失常，80岁以上患者发病率接近10％。房颤的主要危害之一为脑卒中，目前研究认为15％的缺血性脑卒中与房颤有关，非瓣膜病房颤患者发生脑卒中的危险性是没有房颤者的5—7倍。基于此，房颤抗栓治疗已成为房颤规范化治疗的重要组成部分，抗栓治疗的新药物和新技术不断涌现，治疗手段也更趋于个体化。[第一段]     

Anticoagulation for cardioversion of atrial fibrillation

The cardioversion of chronic atrial fibrillation to sinus rhythm carries a thromboembolic risk of 1.5-6%. These events occasionally occur at the time of cardioversion, but more often happen hours or days later. These strokes and other embolic events may occur even where atrial thrombus has been excluded before cardioversion and it has become apparent that, although atrial electrical activity may be restored by cardioversion, normal mechanical atrial function may take longer to recover. Numerous studies have addressed the role of anticoagulation following cardioversion in patients with atrial fibrillation, however, the mechanism of embolic complications as well as the justification of a standard anticoagulation therapy are not fully established. In this review we will try to present an overview of the mechanisms of thrombosis following cardioversion and give an insight into current anticoagulation strategies.     

Anticoagulation in atrial fibrillation and flutter.

Atrial fibrillation and atrial flutter are important risk factors for stroke. Based on a literature search, pathogenesis of thromboembolism, risk assessment in patients, efficacy of anticoagulation therapy and its alternatives are discussed. Special emphasis is put on issues like paroxysmal atrial fibrillation, atrial flutter and anticoagulation surrounding catheter ablation and cardioversion. A strategy for anticoagulation around the time of pulmonary vein ablation is suggested.     

Anticoagulation for atrial fibrillation in the elderly

Atrial fibrillation is a risk factor for stroke, particularly among elderly patients. Multiple trials have established that antithrombotic therapy decreases stroke risk. Aspirin is associated with a relative risk reduction of about 21% and adjusted-dose warfarin (international normalized ratio 2.0-3.0) is associated with a relative risk reduction of about 68%. Warfarin is more effective than aspirin but is used less often than indicated because of hemorrhagic risk and the inconvenience of coagulation monitoring. The oral direct thrombin ximelagatran has been investigated for stroke prevention in patients with atrial fibrillation in two large clinical trials. The results suggest efficacy in a fixed dose compared with well controlled warfarin. Although anticoagulation intensity was not monitored or regulated during treatment with ximelagatran, it was associated with less bleeding than warfarin. Other antithrombotic agents are under development as alternatives to warfarin, but sufficient data are not yet available to justify their clinical use in patients with atrial fibrillation.     

Anticoagulation management in clinical practice: preventing stroke in patients with atrial fibrillation

Atrial fibrillation (AF) is a major and widely recognized risk factor for cardioembolic stroke. Prophylactic therapy for the prevention of stroke in patients with AF is often achieved through oral anticoagulation, specifically with warfarin, which has been used for this purpose for more than 50 years. Although warfarin therapy is effective when implemented appropriately, it is often underutilized and requires consistent monitoring to ensure both safety in avoiding bleeding and efficacy in preventing strokes. Because the burden of AF-related stroke continues to rise, healthcare professionals need to understand the strengths and limitations of current and emerging treatment options. This review outlines current practices for managing the risk of stroke with anticoagulation in patients with AF, and discusses how new oral anticoagulants may affect clinical practice.     

合并冠心病的慢性阻塞性肺疾病患者的急诊用药

冠心病和慢性阻塞性肺疾病(ＣＯＰＤ)均是老年人常见病和多发病 ,两者并发亦较常见。临床上发现冠心病合并肺心病占 10 3%～2 5 6% ,冠心病合并ＣＯＰＤ虽无准确资料统计 ,但百分比肯定更高。ＣＯＰＤ包括慢性支气管炎和慢性阻塞性肺气肿。由于老年人的特殊病理变化 ,所以合并冠心病的ＣＯＰＤ患者急性发作时 ,用药要慎重 ,特别是应避免诱发或加重冠心病的药物。冠心病合并肺心病时 ,左右心室均有病变 ,急性发作时可表现为全心衰竭 ,因此治疗也更为复杂。1　抗生素　　 90 %以上ＣＯＰＤ急性发作由感染诱发 ,因此抗生素应用非常广泛。ＣＯ…     

Anticoagulation in permanent atrial fibrillation after 75 years of age

PURPOSE: More than 10% of the population over 75 years old is concerned by non valvular permanent atrial fibrillation which is responsible for at least 30% of ischemic strokes. The indication of an anticoagulant therapy is discussed in two different situations: primary or secondary prevention of stroke and acute phase of stroke. CURRENT KNOWLEDGE AND KEY POINTS: Patients over 75 years old have a high risk of stroke (> 8% year). All the studies have demonstrated the benefit of a primary or secondary prevention by antivitamin K with an INR between 2 and 3 (reduction of the relative risk of about 68%). Conversely, the efficacy of aspirin has not been proven in this population of elderly patients. Once stroke has occurred, it is not recommended to initiate an anticoagulation (unfractioned or low molecular weight heparin) within the first hours. Prevention of venous thrombosis remains necessary. FUTURE PROSPECTS AND PROJECTS: Currently, less than 30% of the patients older than 75 years are given anticoagulation, the risk of the treatment being probably overestimated. The risk benefit ratio should be evaluated more properly for a given patient.