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Resumen Fundamento y objetivo Los anticoagulantes orales directos (ACOD) precisan ajuste de dosis segun el estimated clearance creatinine (eClCr, «aclaramiento de creatinina estimado») por la ecuacion de Cockcroft-Gault (CG). Existen discrepancias entre las ecuaciones que estiman el filtrado glomerular (FGe). Analizamos como afecta a la posologia recomendada para los ACOD el empleo de las ecuaciones CKD-EPI y MDRD-4 IDMS. Pacientes y metodos Estudio retrospectivo de pacientes con fibrilacion auricular no valvular atendidos en una consulta de cardiologia entre noviembre de 2012 y agosto de 2014. Se reclasifican los pacientes segun la posologia recomendada para dabigatran, rivaroxaban, apixaban y edoxaban en funcion de la ecuacion de FGe empleada. Se tienen en cuenta otros factores clinicos, segun ficha tecnica. Analizamos el porcentaje de discordancia. Resultados Se estudian 454 pacientes, 53,3% hombres, con una edad media de 68,7 ± 13,8 anos. La media de las diferencias intraindividuales registradas respecto a la ecuacion de GC fue de 3,9 ml/min/1,73 m2 con MDRD-4 IDMS (IC 95% 1,4-6,4; p = 0,003) y 11,3 ml/min/1,73 m2 con CKD-EPI (IC 95% 8,9-13,7; p Conclusiones En pacientes con fibrilacion auricular no valvular, especialmente con insuficiencia renal y en ancianos, las ecuaciones de FGe tienden a sobreestimar la funcion renal respecto a CG y, por ello, a recomendar una sobredosificacion de los ACOD.

BACKGROUND: The TIMI‐AF score predicts poor outcomes in patients with atrial fibrillation (AF) and guides selection of anticoagulant therapy by identifying clinical benefit of direct oral anticoagulants (DOACs) or vitamin K antagonists (VKA). HYPOTHESIS: Our objective was to determine the ability to predict cardiovascular events according to the TIMI‐AF score in a real‐world population. METHODS: Retrospective observational study of VKA‐naïve patients with AF was seen at a cardiology outpatient clinic in Spain between November 2012 and August 2014. We recorded adverse events (myocardial infarction, systemic embolism or stroke, major bleeding, and death). RESULTS: The study population comprised of 426 patients (50.7% men, mean age, 69 ± 14 years). The TIMI‐AF score identified 372 patients (87.3%) with a low risk, 50 patients (11.7%) with an intermediate risk, and 4 patients (0.9%) with a high risk. After a mean follow‐up of 423.4 ± 200.1 days, 37 patients (9%) experienced an adverse event. Patients with a TIMI‐AF score ≥ 7 had a poorer cardiovascular prognosis (HR, 6.1; 95%CI, 3.2‐11.7; P < 0.001). The area under the ROC curve of TIMI‐AF was 0.755 (95%CI, 0.669‐0.840; P < 0.001), which was greater than that of CHA(2)DS(2)VASc (0.641; 95%CI, 0.559‐0.724; P = 0.004), HAS‐BLED (0.666; 95%CI, 0.578‐0.755; P < 0.001), and SAMeTT(2)R(2) (0.529; 95%CI, 0.422‐0.636; P = 0.565). Similar results were obtained in relation to the net clinical outcome (life‐threatening bleeding, disabling stroke, or all‐cause mortality). CONCLUSIONS: The TIMI‐AF risk score can identify patients who are at greater risk of cardiovascular events and a poor net clinical outcome with a better diagnostic yield than CHA(2)DS(2)VASc, HAS‐BLED, and SAMeTT(2)R(2).

Aim: To evaluate medication persistence and outcomes in patients with atrial fibrillation after 2 years of treatment with rivaroxaban in routine practice. Methods: Retrospective study of atrial fibrillation patients in whom rivaroxaban was prescribed during the first quarter of 2014 in the healthcare area of Costa del Sol (Málaga). Results: A total of 111 patients (mean age 74.9 ± 10.9 years; 52.3% men; CHA2DS2-VASc 3.6 ± 1.3; HAS-BLED 1.3 ± 0.6) were included. A total of 96.3 and 90.6% of patients remained on rivaroxaban therapy after 1 and 2 years of treatment, respectively. During this period, stroke, net clinical benefit outcome (thromboembolic events, myocardial infarction, cardiovascular death and major bleeding) and cardiovascular death occurred in 3.6, 5.4 and 1.8% of patients, respectively. Conclusion: In routine practice, medication persistence with rivaroxaban was high. Rates of major cardiac events were low.

Background and objective Direct oral anticoagulants (DOACs) require dose adjustment according to estimated clearance creatinine (eClCr) using the Cockcroft–Gault (CG) equation. There are discrepancies with the equations that estimate glomerular filtration rate (eGFR). We analyse how the use of the CKD-EPI and MDRD-4 IDMS equations affect the recommended dosage for ACODs. Patients and methods Retrospective study of patients with non-valvular atrial fibrillation seen at a cardiology clinic between November 2012 and August 2014. Patients were reclassified according to the recommended dosage for dabigatran, rivaroxaban, apixaban and edoxaban, based on the eGFR equation used. Other clinical factors are taken into account, according to the product label. We analysed the percentage of discordance. Results Four hundred and fifty-four patients, 53.3% men, with a mean age of 68.7 ± 13.8 years were studied. The mean intra-individual differences recorded for the CG equation were 3.9 ml/min/1.73 m2 with MDRD-4 IDMS (95% CI 1.4–6.4, p = 0.003) and 11.3 ml/min/1.73 m2 with CKD-EPI (95% CI 8.9–13.7, p Conclusions In patients with non-valvular atrial fibrillation, especially with renal failure and in the elderly, eGFR equations tend to overestimate renal function relative to CG and therefore suggest an overdose of DOACs.

Resumen Presentamos el caso de una paciente que comienza con insuficiencia cardiaca aguda, secundaria a miocardiopatia dilatada no isquemica con fraccion de eyeccion de ventriculo izquierdo severamente deprimida, en que se incluyo ivabradina en el tratamiento durante la fase aguda, obteniendo mejoria clinica y ecocardiografica a corto plazo.