Abstract
Atrial fibrillation is the most frequent clinically significant arrythmia and thanks to its growing prevalence, mostly due to population ageing, it is considered one of the epidemies of 21st century. The importance of atrial fibrillation is mostly seen in its impact on the prognosis of those who suffer from this arrythmia, i.e. beside the negative influence of atrial fibrillation on the function of the heart as a pump, it especially is the multiplied risk of embolism.
This fact has been known since decades and first resulted in periprocedural anticoagulation treatment in electrical or pharmacological version aimed at the sinus rhythm, later it led to searching for the patients who would benefit from the chronic anticoagulation treatment. Such a treatment was, until recently, represented by coumarins, mainly warfarin, which showed a few difficulties such as being not efficcient enough to fully avoid either the embolism or the adverse effect of bleeding complications.In the past few years there was the clinical assessment in place focused at a number of new molecules with anticoagulation effect such as dabigatran, rivaroxaban and apixaban where we have enough of positive reference to include those in our regular therapeutic armamentarium.
This publication was written to find its readers among the internists, cardiologists, neurologists and also general practitioners and aims at the topic of the simultaneously evolving problematics of indications and contraindications of the anticoagulation treatment in atrial fibrillation. The second, substantial part of this publication presents the four molecules mentioned above in closer detail with regard to the level of their records in various clinical situations.
It mainly focuses at the practical usage of those therapeutic modalities where, in case of the new peroral anticoagulants, we are consecutively gaining the experience.