[Cardiac indications for oral anticoagulation].
While considering long-term oral anticoagulation one should assess benefit (i.e., reduction in thromboembolic events) and risks (i.e., bleeding complications) associated with therapy for each individual patient. The classic cardiac indications for oral anticoagulation include chronic atrial fibrillation, prosthetic heart valves, and left ventricular thrombus formation following anterior myocardial infarction. The value of anticoagulation in patients with impaired left ventricular function in stable sinus rhythm and in secondary prevention of coronary artery disease remains controversial. For decades warfarin has been the only compound available. Currently, promising results have been achieved with the oral thrombin inhibitor ximelagatran. In the future, oral anticoagulants, which are administered in fixed dose with no need for monitoring of the anticoagulation level, may replace warfarin. Safety and efficacy of double antiplatelet therapy (aspirin and clopidogrel) in the secondary prevention of thromboembolic events in patients with atrial fibrillation are currently being addressed in large-scale clinical trials.
Roffi
M
M
Herz-Kreislauf-Zentrum, Kardiologie, Universitätsspital, Departement Innere Medizin, Zürich. marco.roffi@usz.ch
Oechslin
E
E
D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000188:drug therapy*; D001384:Azetidines / Q000009:adverse effects / Q000627:therapeutic use; D001596:Benzylamines; D002986:Clinical Trials as Topic; D019918:Heart Valve Prosthesis Implantation; D006352:Heart Ventricles; D006801:Humans; D008134:Long-Term Care; D009203:Myocardial Infarction / Q000188:drug therapy*; D011183:Postoperative Complications / Q000188:drug therapy*; D012307:Risk Factors; D013923:Thromboembolism / Q000188:drug therapy*; D013927:Thrombosis / Q000188:drug therapy*
D000925:Anticoagulants; D001384:Azetidines; D001596:Benzylamines; C426686:ximelagatran