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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.

Resumen Fundamento y objetivo Evaluar en la practica clinica el cumplimiento de las recomendaciones del Informe de Posicionamiento Terapeutico (IPT) de la Agencia Espanola de Medicamentos y Productos Sanitarios sobre el tratamiento con anticoagulantes orales en pacientes ≥ 75 anos con fibrilacion auricular no valvular (FANV) atendidos en unidades de Medicina Interna en Espana. Pacientes y metodos Estudio observacional, transversal y multicentrico, en el que se incluyeron 837 pacientes ≥ 75 anos con FANV en tratamiento estable con anticoagulantes orales durante los 3 meses previos a la inclusion y que hubiesen iniciado dicho tratamiento antes de comenzar el periodo de inclusion. Resultados La edad media fue de 83,0 ± 5,0 anos, el CHADS2 medio 3,2 ± 1,2, el CHA2DS2-VASc 5,0 ± 1,4 y el HAS-BLED 2,1 ± 0,9. El 70,8% de los pacientes estaba en tratamiento con antagonistas de la vitamina K (AVK) y el resto con anticoagulantes orales de accion directa (ACOD). El 65,6% de los pacientes con AVK no siguieron las recomendaciones del IPT frente al 43,0% de los pacientes con ACOD (p Conclusiones En un porcentaje elevado de pacientes ancianos con FANV anticoagulados en Espana no se siguen las recomendaciones realizadas por el IPT, especialmente con los AVK, al no realizarse el cambio a ACOD a pesar de un tiempo en rango terapeutico inadecuado.

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

Background/objectives Several studies have reported that non-alcoholic fatty liver disease (NAFLD) is more frequent in patients with psoriasis, but few have reviewed the presence of liver fibrosis in those patients. Methods Cross-sectional cohort, single-centre study, continuously selecting all patients with moderate-severe psoriasis seen at the Psoriasis Unit of a Tertiary Hospital. The grade of liver steatosis was assessed using liver ultrasound, and the quantity of liver fibrosis was graded using a transitional vibration-controlled elastography (Fibroscan®). Results A total of 71 patients (66.2% male) were included, with an average age of 46.6 years old. The maximum historical PASI average was 14.4 while the baseline PASI average at the time of the study was 2. A third (36%) of patients met the criteria for metabolic syndrome 52% of patients had steatosis; being male, having metabolic syndrome comorbidities, elevated AST/ALT enzymes, dyslipidemia and high initial PASI were significantly related. 14% of patients had moderate liver fibrosis (≥7.6 KPa). In 30% of them, no ultrasound liver steatosis was observed. Conclusions Elastography may be a useful tool along with ultrasound to evaluate liver disease in patients with psoriasis.

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.

Background and objective To evaluate the adherence to the recommendations in clinical practice performed by the Therapeutic Positioning Report (TPR) of the Spanish Agency of Medicines and Sanitary Products about the treatment with oral anticoagulants in patients aged ≥75 years old with nonvalvular atrial fibrillation (NVAF) treated in Internal Medicine departments in Spain. Patients and methods Observational, cross-sectional and multicenter study in which 837 patients aged ≥75 years old with NVAF, with stable treatment with oral anticoagulants at least 3 months before inclusion, and that had started treatment with oral anticoagulants before the inclusion period were included. Results Mean age was 83.0 ± 5.0 years old, mean CHADS2 score 3.2 ± 1.2, mean CHA2DS2-VASc score 5.0 ± 1.4, and mean HAS-BLED score 2.1 ± 0.9. A percentage of 70.8 of patients were treated with vitamin K antagonists (VKA) and the rest of patients with direct oral anticoagulants (DOACs). A percentage of 65.6 of patients treated with VKA did not follow the recommendations made by the TPR compared with 43.0% of patients treated with DOACs (p Conclusions In a high proportion of anticoagulated elderly patients with NVAF in Spain, the recommendations performed by the TPR are not followed, particularly with VKA, since patients are not switched to DOACs despite time in therapeutic range.