Drugs

Drug treatment of atrial fibrillation depends on the cause. In addition, the drugs, known as antiarrhythmics, have clear indications, contraindications and interactions with other drugs. Commonly used drugs in atrial fibrillation are beta blockers, flecainide, propafenone and amiodarone.

Beta-blockers such as bisoprolol are drugs that act on the so-called beta-adrenoreceptors. They are used to treat various heart diseases, such as high blood pressure, cardiac insufficiency, rapid heartbeat (tachycardia) and cardiac arrhythmia such as atrial fibrillation. Beta-blockers can cause side effects such as weight gain or potency problems, they can worsen existing conditions such as bronchial asthma and diabetes mellitus.

In the cardiovascular system, the blood pressure may drop too much, the heartbeat may be too slow and circulatory problems may occur. Long-term therapy of atrial fibrillation generally requires consideration of antithrombotic (blood-thinning) treatment. The aim of this therapy is to make the blood less coagulable and thus prevent the formation of clots (thrombi).

The reason for this is that atrial fibrillation is a frequent cause of strokes and embolisms. If the blood is diluted with medication, the risk of clot formation is reduced. Whether there is an increased risk of strokes and embolisms depends on various factors, which are calculated according to the current guidelines for the treatment of atrial fibrillation with the CHADS2 score.

Whether a medicamentous blood clotting is necessary, decides the treating cardiologist. Anticoagulants used for this purpose would be ASS 100 (e.g. aspirin) or Marcumar (a vitamin K antagonist).If atrial flutter/flicker has persisted for more than 48 h, such therapy is necessary before cardioversion. After cardioversion, anticoagulation is generally initiated for four weeks.

Whether or not prophylaxis against clots is necessary is decided on the basis of age, heart disease and certain risk factors:

Patient: Therapy

Under 60 years, no diseases: No therapy

Under 60 years, heart disease: ASS 300mg/d

Over 60 years, no risks: ASS 300mg/d

Over 60 years, diabetes mellitus or CHD: Marcumar

Over 75 years: Marcumar

Patients (regardless of age) with risk factors such as heart failure, high blood pressure, distended left atrium, hypertyreosis: Marcumar anticoagulants used for this purpose would be ASS 100 (e.g. aspirin) or Marcumar (a vitamin K antagonist). If atrial flutter/flicker has persisted for more than 48 h, such therapy is necessary before cardioversion. After cardioversion, anticoagulation is generally initiated for four weeks.

Whether or not prophylaxis against clots is also necessary is decided on the basis of age, heart disease and certain risk factors: Patient: therapy Under 60 years of age, no diseases: No therapy Under 60 years, heart disease: ASS 300mg/d Over 60 years, no risks: ASS 300mg/d Over 60 years of age, diabetes mellitus or CHD: Marcumar Over 75 years of age: Marcumar Patients (regardless of age) with risk factors heart failure, high blood pressure, distended left atrium, hypertyreosis: MarcumarWhich drugs are used? Vitamin K antagonists, known as Marcumar, have been used for years to thin the blood. Marcumar is used to treat and prevent blood clots and vascular occlusion and to treat heart attacks.

However, Marcumar therapy requires regular coagulation monitoring (INR value). For some years now, there have been new drugs for thinning the blood, the “new oral anticoagulants” (NOAK). These drugs show good efficacy and are easier to use than Marcumar.

These include “thrombin inhibitors” and “factor Xa inhibitors”. Marcumar The blood-thinning drug Marcumar contains the active ingredient phenprocoumon, a “vitamin K antagonist”. In addition to the long-term treatment of a heart attack, it is used for the prevention and therapy of thromboses.

If there is a risk of blood clots forming in atrial fibrillation and causing strokes or embolisms, Marcumar can be used to reduce the risk of clot formation. The dose of the medication is adjusted individually and the doctor regularly measures the state of blood clotting. The INR value is used as a measure of the thick or thin fluid of the blood to adjust Marcumar correctly and to control it permanently.

Some patients report that they feel restricted in their quality of life by the constant blood checks and also describe severe bleeding due to the strong blood thinning. NOAK – new oral anticoagulants The new oral anticoagulants are drugs that act directly on blood clotting and inhibit individual clotting factors. These include the “Factor Xa inhibitors” Apixaban, Rivaroxaban and Edoxaban, and the “Factor IIa inhibitors” Dabigatran etexilate and Argatroban.

Taking these drugs is easier than taking Marcumar because the controls are less complicated. NOAKs are becoming increasingly popular for stroke prophylaxis in atrial fibrillation, but there are no long-term studies on the efficacy of these drugs yet. Additional information can also be found here: Alternatives to Marcumar