Anticoagulación oral en la fibrilación auricular: ¿qué guía el uso de los nuevos fármacos? / Oral anticoagulation in atrial fibrillation: What is the guideline for using new drugs?

Objetivo: Valorar si existen diferencias entre los pacientes con fibrilación auricular (FA) en los que se inicia tratamiento en Urgencias con los anticoagulantes de acción directa (DOAC) y los antivitamina K (AVK). Método: Estudio descriptivo, observacional, prospectivo. Se seleccionaron pacientes con FA que acudieron durante un año a un servicio de urgencias hospitalarias. Resultados: Este estudio incluyó 492 pacientes con FA. Se inició anticoagulación en 189, 104 con AVK (55%) y 85 con DOAC (45%). El grupo AVK: edad media de 76,1 años, 50,9% hombres y 49,1% mujeres, con un CHA2DS2-VASc medio de 3,2±1,3 y un HAS-BLED medio de 1,9±0,8. El grupo DOAC: edad media de 73,4 años, 37,6% hombres y 63,3% mujeres, con un CHA2DS2VASc medio de 3,1±1,6 y un HAS-BLED de 1,7±0,8. Analizando los antecedentes médicos de los pacientes destacó que en el grupo AVK el 17,3% presentaba ACV previo y el 13,5% valvulopatía significativa, y en el grupo DOAC, un 7,1 y un 1,2%, respectivamente. Analizando los diferentes DOAC destacó que en el grupo de dabigatrán el 24,2% presentaba ACV previo y en el de rivaroxabán el 22,7% tenía cardiopatía isquémica. Conclusiones: Los pacientes con FA que inician tratamiento en Urgencias con AVK o con DOAC presentan un perfil similar de edad, sexo y puntuaciones CHA2DS2-VASc y HAS-BLED. Los pacientes con antecedentes de valvulopatía o cardiopatía isquémica recibieron más AVK que DOAC. Si existe antecedente de ictus el DOAC más utilizado es dabigatrán, y si existen antecedentes de cardiopatía isquémica se prefiere rivaroxabán

Objective: To assess whether there are differences between atrial fibrillation (AF) patients initiating new direct-acting oral anticoagulants (DOAC) therapy and vitamin K antagonist (VKA) therapy in an emergency service. Methods: Descriptive, observational, prospective study. We enrolled patients with AF who were visited in a hospital emergency service over one year. Results: This study included 492 patients with AF, and 189 subjects received anticoagulant therapy, 104 with VKA (55%), and 85 with DOAC (45%). The VKA group: mean age 76.1 years, male 50.9% and female 49.1%, CHA2DS2-VASc mean 3.2±1.3 points, and a HAS-BLED mean of 1.9±0.8 points. The DOAC group: mean age 73.4 years, male 37.6% and female 63.3%, CHA2DS2-VASc mean 3.1±1.6 points, and a HAS-BLED mean of 1.7±0.8 points. On analysing the medical history, 17.3% of patients in the VKA group had a previous stroke, and 13.5% significant valve disease, as well as 7.1 and 1.2% of patients, respectively, in the DOAC group. In the analysis of the DOAC types, 24.2% of patients in the dabigatran group had a previous stroke, 22.7% in the rivaroxaban group had ischaemic heart disease. Conclusions: Patients with AF who start on treatment in emergency services with VKA or with DOAC show a similar profile of age, gender, CHA2DS2-VASc score, and HAS-BLED score. The patients with a history of valvular or ischaemic heart disease received more VKA than DOAC. When the patient has a history of stroke, the DOAC more used is dabigatran, and in patients with ischaemic heart disease it is preferred to give rivaroxaban

[Oral anticoagulation in atrial fibrillation: What is the guideline for using new drugs?] / Anticoagulación oral en la fibrilación auricular: ¿qué guía el uso de los nuevos fármacos?

OBJECTIVE: To assess whether there are differences between atrial fibrillation (AF) patients initiating new direct-acting oral anticoagulants (DOAC) therapy and vitamin K antagonist (VKA) therapy in an emergency service. METHODS: Descriptive, observational, prospective study. We enrolled patients with AF who were visited in a hospital emergency service over one year. RESULTS: This study included 492 patients with AF, and 189 subjects received anticoagulant therapy, 104 with VKA (55%), and 85 with DOAC (45%). The VKA group: mean age 76.1 years, male 50.9% and female 49.1%, CHA2DS2-VASc mean 3.2±1.3 points, and a HAS-BLED mean of 1.9±0.8 points. The DOAC group: mean age 73.4 years, male 37.6% and female 63.3%, CHA2DS2-VASc mean 3.1±1.6 points, and a HAS-BLED mean of 1.7±0.8 points. On analysing the medical history, 17.3% of patients in the VKA group had a previous stroke, and 13.5% significant valve disease, as well as 7.1 and 1.2% of patients, respectively, in the DOAC group. In the analysis of the DOAC types, 24.2% of patients in the dabigatran group had a previous stroke, 22.7% in the rivaroxaban group had ischaemic heart disease. CONCLUSIONS: Patients with AF who start on treatment in emergency services with VKA or with DOAC show a similar profile of age, gender, CHA2DS2-VASc score, and HAS-BLED score. The patients with a history of valvular or ischaemic heart disease received more VKA than DOAC. When the patient has a history of stroke, the DOAC more used is dabigatran, and in patients with ischaemic heart disease it is preferred to give rivaroxaban.