Nuevos tratamientos anticoagulantes para la prevención del ictus y la embolia sistémica en la fibrilación auricular no valvular

For 50 years, vitamin K inhibitors have been the only oral anticoagulants available for long-term use in the prevention of embolism in patients with atrial fibrillation. Recently, three studies of antithrombotic drugs with different mechanisms of action have been completed and reported: one involved the thrombin inhibitor dabigatran and two involved the factor-Xa inhibitors rivaroxaban and apixaban. This review describes the designs and results of the three studies. All demonstrated that the new drugs had some clinical advantage over warfarin and, taken together, they offer a better alternative to the use of vitamin K antagonists for preventing stroke and systematic embolism in a large proportion of patients with nonvalvular atrial fibrillation. These new anticoagulant drugs should already be in clinical use. However, it should be remembered that, as with all anticoagulants, there is always a risk of bleeding. Accordingly, it is essential that patients are carefully selected and provided with adequate information.