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Antikoagulantien beim älteren Patienten mit Vorhofflimmern

Antikoagulantien beim älteren Patienten mit Vorhofflimmern. Paul Kyrle. Wiener Intensivmedizinische Tage, Februar 2013. Vorhofflimmern - Risikofaktoren für Insult/systemische Embolie. Swedish Cohort AF Study. ESC Guidelines, Eur Heart J 2012. CHA 2 DS 2 -VASc - Score. Total score. Patients.

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Antikoagulantien beim älteren Patienten mit Vorhofflimmern

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

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

  3. CHA2DS2-VASc - Score Total score Patients stroke rate at 1 yr follow-up (%) 0 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 Vorhofflimmern - Risikofaktoren für Insult/systemische Embolie 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. 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 Risk of anticoagulation-associated bleeding in the elderly Hylek 1994, Fang 2004, Fihn 1996, Steffenson 1997

  8. Wie viele Patienten werden behandelt? 100 80 Gesamteinsatz= 55% 60 61% 58% 57% Indizierter Einsatz von Warfarin (%) 40 44% 35% 20 0 <55 55–64 65–74 75–84 85 Alter (Jahre) Go A et al. Ann Intern Med 1999;131:927–34

  9. 35% 34% 30% Wie lange sind die Patienten im therapeutischen INR-Bereich? 66% 65% 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. ROCKET-AF - stroke and bleeding in pts > 75 yrs Halperin, AHA 2012

  16. VHFL – Antikoagulanzien beim älteren Patienten

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