title: [Prevention of thromboembolism in atrial fibrillation].
abstract: Atrial fibrillation (AF) is the most prevalent chronic arrhythmia in the general population. The prognosis of AF is mainly marked by the associated thromboembolic phenomena. Of every six ischemic strokes, one is due to AF, but the proportion of ischemic strokes attributable to AF increases with age. Thromboembolic risk stratification is a key component of the clinical evaluation of the AF patient, and a clinical performance measure, and should guide the antithrombotic therapeutic strategy. Oral anticoagulation with vitamin K antagonists is effective for the prevention of ischemic stroke in nonvalvular AF but, due to several reasons, it is largely underutilized in daily clinical practice, and INR values are often sub-therapeutic. The new oral anticoagulants (thrombin inhibitors or factor Xa inhibitors) are easier to manage, and don't require laboratorial monitoring. In phase III clinical trials they have shown to be at least as effective as warfarin, but safer, particularly regarding intracranial bleeding, a complication that is responsible for 90% of warfarin-attributable deaths. These results show a potential to increase the proportion of AF patients adequately anticoagulated, which will represent a significant advance in the prevention of stroke attributable to AF.
authors.affiliation: Serviço de Cardiologia, Hospital de Santa Cruz, CHLO, Carnaxide, Portugal. ctaguiar@sapo.pt
authors.forename: Carlos
authors.initials: C
authors.lastname: Aguiar
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications*; D065427:Factor Xa Inhibitors; D006801:Humans; D018570:Risk Assessment; D013917:Thrombin / Q000037:antagonists & inhibitors; D013923:Thromboembolism / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D013917:Thrombin