Vnitr Lek 1996, 42(11):792-795

[Prevention of thromboembolism in patients with atrial fibrillation].

J Veselka, P Bartůněk: IV. interní klinika VFN, Praha.

Atrial fibrillation is a disorder of the cardiac rhythm associated with an increased risk of thromboembolism. Several studies in the past confirmed that anticoagulation or also antiaggregation therapy is associated in these patients with a reduced incidence of cerebrovascular attacks and peripheral embolism. For a more objective assessment of the risk of individual patients risk factors of thromboembolism in atrial fibrillation were defined. They include cardiac insufficiency, hypertension, a history of embolism, left atrial dilatation, systolic dysfunction of left ventricular hypertrophy and spontaneous echo contrast. This risk stratification of patients with atrial fibrillation is the basis for correct selection of subsequent treatment. In patients without risk factors treatment with acetylsalicylic acid can be recommended, if older than 60 years. In younger patients no treatment is necessary for prevention of thromboembolism in this group. In the presence of one or several risk factors permanent anticoagulation treatment with a target value of INR 2.5 is necessary. In patients with atrial fibrillation associated with a congenital or acquired heart disease warfarin is administered with a target value of INR 3-4. The same approach is used in patients with chronic and paroxysmal atrial fibrillation.