Cohen Ariel
Service de cardioloqie, CHU Saint-Antoine, 75571 Paris Cedex 12.
Rev Prat. 2004 Feb 15;54(3):298-307.
The principal complication of the atrial arrythmias is the thrombo-embolic accident, notably the cerebro-vascular accident. The efficacity of the oral anticoagulants in reducing cerebro-vascular accidents has been demonstrated in numerous studies. This is significantly superior to that obtained with the anti-platelet drugs. However, the anti-vitamin K drugs (warfarin) carry a risk of serious haemorrhage of around 5% per year. This restricts the proposal of this treatment to patients with an elevated risk of vascular accidents: age, diabetes, previous cerebro-vascular accidents, and cardiac failure are the risk factors. Nevertheless, the risk of haemorrhage is responsible for an under prescription of the anticoagulants in the elderly. This explains the interest aroused by alternative therapeutics: the results of trials on ximelagatran, a direct anti-thrombin, are promising. In patients with an arrythmia, cardioversion carries a thrombo-embolic risk of around 1%. This risk is reduced by prior anticoagulant treatment. The procedure for this treatment is orientated by a trans-oesophageal echocardiogram. The incertitude of the duration of anticoagulant therapy without cardioversion calls for respect of the arrythmia. The treatment of this is limited to control of the cardiac rhythm and anticoagulant treatment.
房性心律失常的主要并发症是血栓栓塞事件，尤其是脑血管意外。众多研究已证实口服抗凝剂在减少脑血管意外方面的有效性。这明显优于抗血小板药物。然而，抗维生素K药物（华法林）每年有大约5%的严重出血风险。这使得该治疗方案仅适用于血管意外风险较高的患者：年龄、糖尿病、既往脑血管意外和心力衰竭均为风险因素。尽管如此，出血风险导致老年人对抗凝剂的处方量不足。这就解释了替代疗法所引发的兴趣：对直接抗凝血酶药物希美加群的试验结果很有前景。对于心律失常患者，心脏复律有大约1%的血栓栓塞风险。预先进行抗凝治疗可降低该风险。这种治疗方法以经食管超声心动图为指导。在未进行心脏复律的情况下，抗凝治疗持续时间的不确定性要求重视心律失常。对此的治疗仅限于控制心律和抗凝治疗。
