Binggeli Christian, Brunckhorst Corinna B
HerzKreislaufZentrum, Klinik für Kardiologie, Departement für Innere Medizin, Universitätsspital Zürich, Rämistrasse 100, 8091 Zürich, Schweiz.
Herz. 2008 Feb;33(1):13-9. doi: 10.1007/s00059-008-3090-8.
Atrial fibrillation is the most common arrhythmia in the elderly and is associated with substantial morbidity and mortality, mostly due to the consequences of thromboembolism. Anticoagulation reduces the risk of stroke and death considerably, the risk reduction depending on the patient's absolute risk. Although there is modest benefit from acetylsalicylic acid, randomized trials have shown that it is consistently and substantially less effective than vitamin K antagonists. These benefits must be balanced against an increased risk of bleeding. In addition, warfarin therapy imposes a variety of lifestyle constraints, including frequent blood test monitoring and, possibly, dietary modification, and is associated with a number of drug interactions. Careful assessment of the absolute risk of stroke on the one hand and bleeding complications on the other hand will guide the use of appropriate prophylaxis against thromboembolism and its consequences.
心房颤动是老年人中最常见的心律失常，与较高的发病率和死亡率相关，主要是由于血栓栓塞的后果。抗凝治疗可显著降低中风和死亡风险，风险降低程度取决于患者的绝对风险。虽然乙酰水杨酸有一定益处，但随机试验表明，它始终比维生素K拮抗剂效果差得多。这些益处必须与出血风险增加相权衡。此外，华法林治疗对生活方式有多种限制，包括频繁的血液检测监测，可能还需要饮食调整，并且会有多种药物相互作用。一方面仔细评估中风的绝对风险，另一方面评估出血并发症，将指导使用适当的预防措施来预防血栓栓塞及其后果。
