[Anticoagulant therapy for chronic cardiac diseases. Atrial fibrillation, valvular heart disease, congestive heart failure].
In cardiology, anticoagulant therapy is absolutely indicated after mechanical valve replacement, but is much more often necessary as a prophylactic measure in atrial fibrillation for prevention of embolic stroke. For more than 50 years, there has been no alternative to the oral application of vitamin K antagonists (VKA), which are known to have a very narrow therapeutic window. Despite being highly effective in preventing embolic stroke, many patients are not adequately treated with VKA, and up to 45% of the time the values lie outside the therapeutic range. The reasons for this might be difficult adjustment of VKA dosage, interactions with drugs and food, the necessity of constant monitoring of the blood coagulation, and the fear of severe bleeding complications. More recently, different anticoagulants binding directly to thrombin or factor Xa have been developed, which allows anticoagulant therapy without the need for numerous coagulation checks, representing a major breakthrough in anticoagulant therapy. In this review, the new guidelines for the use of antithrombotic therapy in atrial fibrillation are presented, followed by a discussion of study results with the new thrombin inhibitors and factor Xa inhibitors for prevention of thromboembolic stroke. Moreover, principles of anticoagulant therapy in valvular heart disease and chronic heart failure are described.
Medizinische Klinik II-Kardiologie und Pulmologie, Charité, Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin. bernhard.witzenbichler@charite.de
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Witzenbichler
D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy; D002309:Cardiology / Q000592:standards*; D002908:Chronic Disease; D005060:Europe; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006331:Heart Diseases / Q000188:drug therapy*; D006333:Heart Failure / Q000188:drug therapy; D006349:Heart Valve Diseases / Q000188:drug therapy; D006801:Humans; D007388:Internal Medicine / Q000592:standards*; D017410:Practice Guidelines as Topic; D013927:Thrombosis / Q000188:drug therapy* / Q000517:prevention & control
D000925:Anticoagulants; D005343:Fibrinolytic Agents