Beneficios y riesgos de los anticoagulantes orales en la fibrilación auricular

Atrial fibrillation is associated with high morbidity and mortality, which are principally due to an increased risk of thromboembolism – the risk of stroke and systemic embolism are elevated five-fold. Moreover, strokes secondary to atrial fibrillation are associated with higher mortality, greater dependency and poorer recovery, and there is a high rate of recurrence. Anticoagulant treatment decreases the risk of thrombotic events; compared with placebo, the rate of strokes is reduced by 64% and mortality is reduced by 26%.However, anticoagulant treatment is associated with an increased risk of hemorrhagic complications. In particular, the risk of intracranial hemorrhage, a fatal complication, is increased. The emergence of direct oral anticoagulants has not only improved the efficacy of anticoagulant treatment but, importantly, has also increased its safety. However, as patients do not all have the same thromboembolic and hemorrhagic risks, it is essential that these risks are evaluated in individual patients with atrial fibrillation and that potentially modifiable hemorrhagic risk factors are identified. Finally, it is important that anticoagulant drug treatment is adjusted to suit the individual patient to optimize the benefits of treatment whilesimultaneously reducing the risks.

Supplement information: this article is part of a supplement entitled “Treatment of patients with atrial fibrillation undergoing percutaneous coronary intervention: an update”, which is sponsored by Boehringer Ingelheim.