Paciente con alto riesgo cardiovascular y fibrilación auricular: papel del rivaroxabán

Vivencio Barrios , David Vivas , Felipe Atienza Fernández , Miguel Ángel Arias , Raquel Diaz Simón , Aquilino Sánchez Purificación , Gonzalo Barón-Esquivias
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引用次数: 0

Abstract

Traditionally the primary aim of anticoagulation in patients with atrial fibrillation was the prevention of stroke. However, these patients actually have numerous comorbidities that also have a substantial impact on prognosis and that must be treated. These considerations should also play a role in selecting the best anticoagulant treatment for patients with a high cardiovascular risk. In general, direct oral anticoagulants have consistently been shown to have superior efficacy and safety to warfarin, irrespective of whether patients have a history of stroke, transient ischemic attack, diabetes, renal insufficiency or myocardial infarction. In particular, studies have shown that rivaroxaban is associated with a lower risk of myocardial infarction and fewer renal complications than warfarin. In a subgroup study of the ROCKET-AF trial, it was found that rivaroxaban significantly reduced cardiovascular mortality in patients with diabetes mellitus (by 20%). Moreover, studies carried out in routine clinical practice showed that the drug significantly reduces the risk of both major cardiovascular events and peripheral artery disease. As a result, rivaroxaban could be considered the preferred option for anticoagulation in patients with nonvalvular atrial fibrillation and a high cardiovascular risk, given the additional benefits it provides in this population.

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高危心血管和心房颤动患者:利伐沙班的作用
传统上,房颤患者抗凝治疗的主要目的是预防脑卒中。然而,这些患者实际上有许多合并症,这些合并症对预后也有重大影响,必须进行治疗。这些因素也应在为心血管高危患者选择最佳抗凝治疗时发挥作用。总的来说,直接口服抗凝剂一直被证明具有优于华法林的疗效和安全性,无论患者是否有中风、短暂性脑缺血发作、糖尿病、肾功能不全或心肌梗死史。特别是,研究表明,与华法林相比,利伐沙班与更低的心肌梗死风险和更少的肾脏并发症相关。在ROCKET-AF试验的一项亚组研究中,发现利伐沙班显著降低糖尿病患者心血管死亡率(降低20%)。此外,在常规临床实践中进行的研究表明,该药可显著降低主要心血管事件和外周动脉疾病的风险。因此,考虑到利伐沙班在这一人群中提供的额外益处,可以认为利伐沙班是非瓣膜性心房颤动和心血管高危患者抗凝治疗的首选。
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来源期刊
Revista Espanola de Cardiologia Suplementos
Revista Espanola de Cardiologia Suplementos Medicine-Cardiology and Cardiovascular Medicine
CiteScore
1.20
自引率
0.00%
发文量
1
期刊介绍: Revista Española de Cardiología, is an international scientific journal dealing with cardiovascular medicine. Revista Española de Cardiología, the official publication of the Spanish Society of Cardiology, publishes research articles related to cardiovascular diseases. Articles are published in Spanish for the paper edition and in both Spanish and English in the electronic edition, which is available on the Internet. Regular sections include original articles reporting clinical or basic research, brief reports, review articles, editorials and letters to the Editor.
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