title: [Current management of antithrombotic treatment in patients with non valvular atrial fibrillation and prior history of stroke or transient ischemic attack].
abstract: Atrial fibrillation is the most frequent arrhythmia seen in clinical practice and is one of the most important risk factors for suffering a stroke. Strokes associated to atrial fibrillation are more severe, present higher mortality and disability rates, and there is a greater risk of recurrence. Consequently, both primary and secondary prevention of stroke associated to atrial fibrillation by means of suitable antithrombotic treatment is clearly essential in order to lower this risk. Chronic oral anticoagulants are the cornerstone of antithrombotic treatment in patients with non-valvular atrial fibrillation, especially in those who have already had a stroke. Vitamin K antagonists have traditionally been used for this purpose. Yet, these drugs have several important disadvantages (narrow therapeutic window, unpredictable response, numerous interactions with drugs and foods, as well as starting and finishing their action slowly), which limit their use in clinical practice. The new oral anticoagulants not only overcome these disadvantages but also have proved to be at least as effective as warfarin in the prevention of strokes and systemic embolism in patients with non-valvular atrial fibrillation. Additionally, they have been shown to have a better safety profile, especially with an important drop in the risk of intracranial haemorrhage, regardless of the antecedents of stroke or transient ischaemic attack, which makes them first-choice drugs in the treatment of these patients.
authors: Hospital Universitario Ramon y Cajal, 28034 Madrid, Espana.
authors: Jaime
authors: J
authors: Masjuán
authors: José
authors: J
authors: Álvarez-Sabín
authors: Miguel
authors: M
authors: Blanco
authors: Alicia
authors: A
authors: de Felipe
authors: Antonio
authors: A
authors: Gil-Núñez
authors: Jaime
authors: J
authors: Gállego-Culleré
authors: José
authors: J
authors: Vivancos
mesh_terms: D000284:Administration, Oral; D001281:Atrial Fibrillation / Q000150:complications*; D002986:Clinical Trials as Topic; D019468:Disease Management; D015507:Drugs, Investigational / Q000627:therapeutic use; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000145:classification / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology / Q000517:prevention & control*; D002546:Ischemic Attack, Transient / Q000209:etiology* / Q000517:prevention & control; D015337:Multicenter Studies as Topic; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke / Q000209:etiology* / Q000517:prevention & control; D019851:Thrombophilia / Q000188:drug therapy* / Q000209:etiology
chemical_list: D015507:Drugs, Investigational; D005343:Fibrinolytic Agents