van den Donk Maureen, Opstelten Wim
*Namens de NHG-werkgroep Atriumfibrilleren, waarvan de leden aan het eind van dit artikel worden vermeld.
Ned Tijdschr Geneeskd. 2013;157(38):A6697.
A small number of points in the NHG practice guideline 'Atrial fibrillation' have been reviewed; this has important consequences for general practice. The risk of ischaemic CVA in patients with atrial fibrillation is determined using a new risk score (CHA2DS2-VASc). The target value of the resting ventricular frequency has been increased from a maximum of 90 to a maximum of 110 beats per minute. Oral anticoagulants are indicated in almost all patients aged 65 years and older with atrial fibrillation; the only group in whom antithrombotic medication is not indicated is men under the age of 75 with no cardiovascular comorbidity. Acetylsalicylic acid for the prevention of thrombo-embolism is only indicated if oral anticoagulants are contra-indicated. The new oral anticoagulants (NOACs) have very limited use in the prevention of a thrombo-embolism in general practice.
荷兰全科医学指南《心房颤动》中的少数要点已被重新审视；这对全科医学具有重要影响。心房颤动患者缺血性脑卒中的风险通过一种新的风险评分（CHA2DS2-VASc）来确定。静息心室率的目标值已从每分钟最高90次增加到最高110次。几乎所有65岁及以上的心房颤动患者都需使用口服抗凝剂；唯一不建议使用抗血栓药物的群体是75岁以下无心血管合并症的男性。只有在口服抗凝剂禁忌时，才使用乙酰水杨酸预防血栓栓塞。新型口服抗凝剂（NOACs）在全科医学中预防血栓栓塞的应用非常有限。
