title: [Use of non-vitamin K antagonist oral anticoagulants in Primary Care: ACTUA study].
abstract: OBJECTIVE
  Approximately 40% of patients with non-valvular auricular fibrillation (NVAF) who receive vitamin K antagonists (VKA) in Primary Care in Spain have poor anticoagulation control. The objective of the study Actuación en antiCoagulación, Tratamiento y Uso de anticoagulantes orales de acción directa (ACOD) en Atención primaria (ACTUA) (Action in Coagulation, Treatment and Use of direct oral anticoagulants [DOACs]) in Primary Care) was to analyse the current situation regarding the use of VKA and non-vitamin K antagonist oral anticoagulants (NOACs) in patients with NVAF in Primary Care in Spain and the possible issues arising from it.
  
  
  METHODS
  An online survey was created covering various aspects of the use of oral anticoagulants in NAFV. A two-round modified Delphi approach was used. Results were compiled as a set of practical guidelines.
  
  
  RESULTS
  Forty-four experts responded to the survey. Consensus was reached in 62% (37/60) of the items. Experts concluded that a considerable number of patients with NVAF who receive VKA do not have a well-controlled INR and that a substantial group of patients who could benefit from being treated with NOACs do not receive them. The use of NOACs increases the probability of having good anticoagulation control and decreases the risk of severe and intracranial haemorrhage. Current limitations to the use of NOACs include administrative barriers, insufficient knowledge about the benefits and risks of NOACs, limited experience of doctors in using them, and their price. Renal insufficiency influences the choice of a particular anticoagulant.
  
  
  CONCLUSIONS
  The ACTUA study highlights the existing controversies about the use of oral anticoagulants for the treatment of NVAF in Primary Care in Spain, and provides consensus recommendations that may help to improve the use of these medications.
authors.affiliation: Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, España. Electronic address: vivenciobarrios@gmail.com.
authors.forename: V
authors.initials: V
authors.lastname: Barrios
authors.affiliation: Servicio de Cardiología, Hospital Universitario La Paz, Madrid, España.
authors.forename: C
authors.initials: C
authors.lastname: Escobar
authors.affiliation: Medicina de Familia y Comunitaria, Centro de Salud Jazmín, Madrid, España.
authors.forename: J M
authors.initials: JM
authors.lastname: Lobos
authors.affiliation: Medicina de Familia y Comunitaria, Centro de Salud Cásar, Cáceres, España.
authors.forename: J
authors.initials: J
authors.lastname: Polo
authors.affiliation: Grupo de Anticoagulación, Sociedad Española de Medicina General y de Familia (SEMG), Madrid, España.
authors.forename: D
authors.initials: D
authors.lastname: Vargas
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D003697:Delphi Technique; D006801:Humans; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D013030:Spain; D011795:Surveys and Questionnaires
chemical_list: D000925:Anticoagulants
keywords: Antagonistas de la vitamina K; Anticoagulación; Anticoagulantes orales de acción directa; Anticoagulation; Delphi process; Direct oral anticoagulants; Fibrilación auricular no valvular; Método Delphi; Nonvalvular atrial fibrillation; Vitamin K antagonists