El cambio de paradigma en la prevención de ictus en la fibrilación auricular. Retos y oportunidades emergentes para el médico de familia

Atrial fibrillation (AF), is the most prevalent sustained arrhythmia in general population, affecting up to 10% in patients of advanced age. AF doubles overall mortality and increases up to 5–6 times the risk of stroke, which have the characteristic of being particularly harmfull. The basis of treatment on AF are the rhythm or rate control and the prevention of thromboembolism. For the latter purpose the treatments that have been most effective are oral acticoagulants. For decades and until just a few years ago, the only oral drugs available for this purpose have been the anti-vitamin K, mainly represented in our country by acenocoumarol and lesser extent by warfarin. These drugs have been shown to reduce strokes and mortality compared to placebo and with antiplatelet drugs, so have been and continue to be the standard treatment and the comparator for all antithrombotic drugs in patients with AF. The variability in the therapeutic response, their food and drugs interactions and their narrow therapeutic window that entail the need to frequently monitoring, has led to look for new drugs that, at least maintaining their advantages, where able to avoid some of the drawbacks. Currently we have a number of new drugs that meet these premises, although they have the disadvantage of a higher direct cost. The arrival of these new oral anticoagulants (NOAC) make necessary to know them well, reach a consensus for a correct use and to make changes in the clinical management of these patients when they are used. In this article we review the indications and way of use of the different options (classics and news) of antithrombotic therapy in patients with AF, the situation of anticoagulated patients in our country, the characteristics of the NOAC, its recommendations for use and the challenges to that are subjected family physicians regarding these changes.