Antikoagulantien beim älteren Patienten mit Vorhofflimmern

Präsentation zum Thema: "Antikoagulantien beim älteren Patienten mit Vorhofflimmern"—  Präsentation transkript:

1 Antikoagulantien beim älteren Patienten mit Vorhofflimmern
Paul Kyrle Wiener Intensivmedizinische Tage, Februar 2013

2 Swedish Cohort AF Study
Vorhofflimmern - Risikofaktoren für Insult/systemische Embolie Swedish Cohort AF Study ESC Guidelines, Eur Heart J 2012

3 stroke rate at 1 yr follow-up (%)
Vorhofflimmern - Risikofaktoren für Insult/systemische Embolie CHA2DS2-VASc - Score CHA2DS2-VASc criteria Score Congestive heart failure/ left ventricular dysfunction 1 Hypertension Age 75 yrs 2 Diabetes mellitus Stroke/transient ischaemic attack/TE Vascular disease (prior myocardial infarction, peripheral artery disease or aortic plaque) Age 65–74 yrs Sex category (i.e. female gender) Total score Patients stroke rate at 1 yr follow-up (%) 6369 0.8 1 8203 2.0 2 12771 3.7 3 17371 5.9 4 13887 9.27 5 8942 15.3 6 4244 19.7 7 1420 21.5 8 285 22.4 9 46 23.6 ESC Guidelines, Eur Heart J 2012

4 ESC Guidelines, Eur Heart J 2012

5 x 100 patient-yrs fatal major minor Palareti, Lancet 1999

6 Bleeding Thrombosis Palareti, Arch Intern Med 2000

7 Risk of anticoagulation-associated bleeding in the elderly
Higher risk of major bleeding (2.1% pt/y vs. 1.1% pt/y) 2.5-fold higher risk of ICH in pts > 85 yrs Annual incidence of ICH between 0.2% and 1% Higher bleeding risk outside clinical studies 1.4-fold increase in ICH per decade of age There are 2 important consequences of recurrent venous thromboembolism. One complication is the development of the post-thrombotic syndrome, or worsening of an preexisting PTS if venous thrombosis occurs in the same leg. The PTS is often associated with serious consequences for patient, such as life-style alterations, loss of work or frequent hospitalizations. It also results in a considerable increase in health costs. Much more important, 5 to 10 percent of the patients with recurrent thrombosis die from pulmonary embolism. Therfore, prevention of recurrent VTE is of utmost clinical importance. Hylek 1994, Fang 2004, Fihn 1996, Steffenson 1997 7

8 Wie viele Patienten werden behandelt?
Indizierter Einsatz von Warfarin (%) Gesamteinsatz = 55% Alter (Jahre) 100 <55 80 60 40 20 55–64 65–74 75–84 85 44% 58% 61% 57% 35% Go A et al. Ann Intern Med 1999;131:927–34 8

9 Wie lange sind die Patienten im therapeutischen INR-Bereich?
35% 34% 30% 65% 66% 70% (1) Eichinger (2012), (2) RE-LY (NEJM 2009), (3) Watzke (Thromb Res 2002)

10 HAS-BLED Risiko-Score

11 ESC Guidelines 2012

12 ESC Guidelines, Eur Heart J 2012

13 RE-LY – bleeding according to age (intracranial)
Eikelboom, Ciculation 2011

14 RE-LY – bleeding according to age (extracranial)
Eikelboom, Ciculation 2011

15 RE-LY - stroke and bleeding in pts > 75 yrs
Eikelboom, Ciculation 2011

16 ROCKET-AF - stroke and bleeding in pts > 75 yrs
Halperin, AHA 2012

17 VHFL – Antikoagulanzien beim älteren Patienten