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Resumen Tanto la diabetes mellitus como la enfermedad renal cronica aumentan el riesgo de fibrilacion auricular. A su vez, la concomitancia de diabetes mellitus y enfermedad renal cronica incrementa de manera sinergica el riesgo tromboembolico asociado con la fibrilacion auricular, lo que pone al paciente en esta situacion en especial riesgo y obliga a no fijar nuestra actuacion solo en la reduccion del riesgo embolico, sino a buscar una proteccion general. Aunque todos los anticoagulantes orales reducen eficazmente el riesgo de ictus en el paciente diabetico con fibrilacion auricular, hay datos que indican que el rivaroxaban podria disminuir ademas la mortalidad cardiovascular en esta poblacion, ofreciendo una proteccion adicional. Por otra parte, se ha descrito un empeoramiento de la funcion renal con el empleo de los antagonistas de la vitamina K (nefropatia por warfarina). En consecuencia, seria deseable que el tratamiento anticoagulante no solo disminuyera el riesgo de complicaciones tromboembolicas, sino que ademas no se asociara con este deterioro de la funcion renal. En este sentido, parece que algunos anticoagulantes orales de accion directa, como el dabigatran y el rivaroxaban, tendrian un menor riesgo de eventos renales adversos en comparacion con warfarina.

Carmen Suárez Fernández,1 Luis Castilla-Guerra,2 Jesus Cantero Hinojosa,3 Josep Maria Suriñach,4 Fernando Acosta de Bilbao,5 Juan José Tamarit,6 José Luis Diaz Diaz,7 Jose Luis Hernandez,8 Antonio Pose,9 Manuel Montero-Pérez-Barquero,10 Jaume Roquer,11 Jaime Gállego,12 José Vivancos,13 Jose María Mostaza141Internal Medicine Service, Hospital Universitario de La Princesa, Madrid, 2Internal Medicine Department, Hospital Virgen Macarena, Seville, 3Internal Medicine Service, Hospital San Cecilio, Granada, 4Internal Medicine Service, Hospital Vall D Hebron, Barcelona, 5Internal Medicine Service, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, 6Internal Medicine Service, Hospital General De Valencia, Valencia, 7Internal Medicine Service, Complejo Universitario Hospitalario de A Coruña, La Coruña, 8Internal Medicine Service, Hospital Marqués de Valdecilla, Universidad de Cantabria, Santander, 9Internal Medicine Service, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, 10Internal Medicine Service, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Reina Sofía, Universidad de Córdoba, Córdoba, 11Neurology Service, Hospital del Mar, Barcelona, 12Neurology Service, Complejo Hospitalario de Navarra, Pamplona, Navarra, 13Neurology Service, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, 14Internal Medicine Service, Hospital Carlos III, Madrid, Spain Background: Although, by itself, atrial fibrillation is associated with an impairment of quality of life antithrombotic therapy may play a role.Objective: To evaluate the satisfaction with anticoagulant treatment in patients with nonvalvular atrial fibrillation who attended internal medicine departments in Spain.Methods: Patients from two different cross-sectional studies were combined. To measure the satisfaction with anticoagulant treatment, the Anti-Clot-Treatment Scale (ACTS) questionnaire was completed by every patient. A multivariate analysis was performed to determine the variables associated with satisfaction of patients receiving oral anticoagulants.Results: A total of 1,309 patients (mean age 78.5±8.4 years; 49.3% men; CHA2DS2VASC 4.9±1.5; HAS-BLED 2.0±0.9) were included in the study, of whom 902 (68.9%) were taking vitamin K antagonists (VKA) and 407 (31.1%) direct oral anticoagulants (DOACs). Overall, satisfaction with oral anticoagulation was high (ACTS Burdens scale 49.69±9.45; ACTS Benefits scale 11.35±2.61). The perceived burdens with anticoagulant treatment were lower in men, as well as in patients with no dependency, normal renal function, who were not polymedicated, or who had moderate bleeding risk. Among patients taking VKA, those subjects with a lower number of International Normalized Ratio (INR) determinations in the last 6 months or with an optimal time in the therapeutic range exhibited a lower perceived burden. Patients taking DOACs (vs VKA) showed a lower perceived burden with anticoagulation. Benefits with anticoagulation were higher in men, younger patients, those with no dependency, or low bleeding risk. Perceived benefits were higher in patients taking DOACs (vs VKA).Conclusion: Satisfaction with oral anticoagulation was high in patients with nonvalvular atrial fibrillation, who were attending internal medicine departments daily in Spain. Among patients taking VKA, those subjects with a lower number of INR determinations in the last 6 months or with an optimal time in the therapeutic range exhibited a lower perceived burden with anticoagulant therapy. Patients taking DOACs (vs VKA) showed lower perceived burdens and higher perceived benefits with anticoagulation. Keywords: atrial fibrillation, benefit, burdens, direct oral anticoagulants, satisfaction, vitamin K antagonists

Aim: To analyze the use of oral anticoagulants in elderly patients with atrial fibrillation in clinical practice. Patients & methods: Cross-sectional and multicenter study performed in atrial fibrillation patients ≥75 years treated with oral anticoagulants ≥3 months. Results: 837 patients (83.0 ± 5.0 years; CHA 2 DS 2 -VASc 5.0 ± 1.4; HAS-BLED 2.1 ± 0.9; 70.8% vitamin K antagonists; 29.2% direct oral anticoagulants [DOACs]) were included. Poor adherence was observed in 27.9% of patients. Higher scores in the Pfeiffer’s test and FRAIL scale were associated with poorer adherence. Among patients treated with DOACs, 62.3% received the lower doses. Having high CHADS 2 score and being older were associated with the use of low doses. Conclusion: 28% of patients had a poor adherence to anticoagulant treatment. 62% of patients were treated with the lower doses of DOACs.