2014, Number 2
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ABSTRACTBackground: Atrial fibrillation, affecting 2% of the population, will be double in the next 50 years. Males are more affected. This disease doubles the rated of: death, cerebrovascular accident, thromboembolic events at other levels, heart failure and hospitalizations. To reduce symptoms and complications antithrombotic or anticoagulant treatment, or the control of the rhythm or ventricular rate and concomitant heart disease are basic.
Objective: To observe the safety of the new oral anticoagulants compared with vitamin K inhibitors.
Patients and method: An observational and prospective study was done with selected patients with non-valvular atrial fibrillation attended at Zacatecas General Hospital from April 2012 to May 2013. To choose antithrombotic or anticoagulant patients were evaluated with CHA2DS2- VASc: Score l aspirin, score 2 or more: dabigatran, rivaroxaban or warfarin, by systematic selection. EHRA classification was employed. Atrial fibrillation was classified in: paroxysmal, persistent, persistent, prolonged or permanent. Endpoints were: stroke, systemic embolism and mortality. A safety criterion was severe bleeding.
Results: Thirty-seven patients with non-valvular atrial fibrillation were included, 23 women and 14 men; 97.2% over 50 years; 33 with permanent atrial fibrillation. Two had CHA2DS2-VASc score of 1 and were treated with acetylsalicylic acid, 35 with a score of 2 or more were given vitamin K inhibitors (n=24), dabigatran (n=6) and rivaroxaban (n=5).
Conclusions: Complications were: stroke in 10, hemorrhagic diathesis in 9 and mortality in 2 (5.1%). The incidence of stroke (27%) and bleeding diathesis (24%) is high compared with other reports (1.6% and 3.3%, respectively) and are caused by an inadequate anticoagulation. Based on the evaluation criteria and safety criteria, the new oral anticoagulants showed better results than vitamin K inhibitors, in absolute numbers but without statistical significance; these results allow the introduction of a new treatment.
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