Con la colaboración de:

La fibrilación auricular (FA) es un problema frecuente en el paciente anciano, un segmento poblacional que presenta el mayor riesgo tromboembólico y, a la vez, las mayores dificultades para un manejo correcto de la anticoagulación. Sin embargo, la principal causa de muerte en pacientes con fibrilación auricular no es el ictus ni la hemorragia, si no el evento cardiovascular.

Cristina Lozano analiza con Javier García Seara, Jaume Francisco y M.ª Emilce Trucco la evidencia en este campo y las recomendaciones de las guías europeas, que invitan a ir más allá de la anticoagulación y el control de síntomas para realizar un abordaje integral del paciente con un correcto manejo de los factores de riesgo cardiovascular y las comorbilidades.

Participantes:

Cristina Lozano Granero
Hospital Universitario Ramón y Cajal, Madrid. Coordinadora CardioPODCAST

Francisco J. García Seara
Hospital Clínico Universitario de Santiago

Jaume Francisco Pascual
Hospital Universitari Vall d'Hebron, Barcelona

M.ª Emilce Trucco Vernetti
Hospital Universitari de Girona Dr. Josep Trueta

• Efficacy and safety of rivaroxaban compared with warfarin among elderly patients with nonvalvular atrial fibrillation in the Rivaroxaban Once Daily, Oral, Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF). Circulation. 8 de julio de 2014;130(2):138-46.
• Efficacy and Safety of Edoxaban in Elderly Patients With Atrial Fibrillation in the ENGAGE AF-TIMI 48 Trial. J Am Heart Assoc. 20 de mayo de 2016;5(5):e003432.
• Efficacy and safety of apixaban compared with warfarin according to age for stroke prevention in atrial fibrillation: observations from the ARISTOTLE trial. Eur Heart J. 21 de julio de 2014;35(28):1864-72.
• Effects of dabigatran according to age in atrial fibrillation. Heart Br Card Soc. julio de 2017;103(13):1015-23.
• Safety of Switching From a Vitamin K Antagonist to a Non-Vitamin K Antagonist Oral Anticoagulant in Frail Older Patients With Atrial Fibrillation: Results of the FRAIL-AF Randomized Controlled Trial. Circulation. 23 de enero de 2024;149(4):279-89.
• Oral anticoagulants and outcomes in adults ≥80 years with atrial fibrillation: A global federated health network analysis. J Am Geriatr Soc. agosto de 2022;70(8):2386-92.
• Bleeding risk with rivaroxaban compared with vitamin K antagonists in patients aged 80 years or older with atrial fibrillation. Heart Br Card Soc. septiembre de 2021;107(17):1376-82.
• Warfarin-related nephropathy occurs in patients with and without chronic kidney disease and is associated with an increased mortality rate. Kidney Int. julio de 2011;80(2):181-9.
• On-Treatment Outcomes in Patients With Worsening Renal Function With Rivaroxaban Compared With Warfarin: Insights From ROCKET AF. Circulation. 5 de julio de 2016;134(1):37-47.
• Rivaroxaban vs. warfarin and renal outcomes in non-valvular atrial fibrillation patients with diabetes. Eur Heart J Qual Care Clin Outcomes. 1 de octubre de 2020;6(4):301-7.
• Rivaroxaban’s Impact on Renal Decline in Patients With Nonvalvular Atrial Fibrillation: A US MarketScan Claims Database Analysis. Clin Appl Thromb Off J Int Acad Clin Appl Thromb. 2019;25:1076029619868535.
• 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons. Circulation. 9 de julio de 2019;140(2):e125-51.
• Renal Outcomes in Anticoagulated Patients With Atrial Fibrillation. J Am Coll Cardiol. 28 de noviembre de 2017;70(21):2621-32.
• Thromboembolic and bleeding events with rivaroxaban in clinical practice in Spain: impact of inappropriate doses (the EMIR study). J Comp Eff Res. mayo de 2021;10(7):583-93.
• Values and Preferences of Physicians and Patients With Nonvalvular Atrial Fibrillation Who Receive Oral Anticoagulation Therapy for Stroke Prevention. Can J Cardiol. junio de 2016;32(6):747-53.
• Safety and efficacy of cryoballoon ablation for the treatment of atrial fibrillation in elderly patients. Clin Res Cardiol Off J Ger Card Soc. febrero de 2019;108(2):167-74.
• Clinical outcomes of radiofrequency catheter ablation of atrial fibrillation in octogenarians-10-year experience of a one high-volume center. J Geriatr Cardiol JGC. septiembre de 2017;14(9):575-81.
• The Impact of Age on 5-Year Outcomes After Atrial Fibrillation Catheter Ablation. J Cardiovasc Electrophysiol. febrero de 2016;27(2):141-6.