Fibrilación auricular y ERC: nuevos anticoagulantes en la insuficiencia renal
La fibrilación auricular (FA) es la arritmia más frecuente en la práctica clínica. La prevalencia en la población general es del 2%, pero se está detectando un incremento en los últimos años. Este incremento se ha asociado a un envejecimiento progresivo de la población y a un mejor control y tratamiento de la patología crónica (cardíaca y no cardíaca). Tal y como ocurre en la FA, la prevalencia de la enfermedad renal crónica (ERC) aumenta en paralelo con la edad y la presencia de otras comorbilidades asociándose a un incremento en el riesgo de mortalidad, hospitalización y acontecimientos cardiovasculares. Además, existe una relación positiva entre ERC, edad, hipertensión arterial, insuficiencia cardíaca, fibrilación auricular, enfermedad coronaria, ictus, enfermedad vascular periférica, dislipemia y diabetes. La prevalencia de ERC en España es del 9,24% mostrando un filtrado glomerular estimado menor de 60 ml/min/1,73 m2 el 6,83% de la población.
En el link cardiovascular existe una asociación y relación bidireccional entre la ERC y la FA. Esta última ha sido olvidada en la literatura en pacientes con ERC hasta tiempos recientes, pero actualmente protagonista de renovado interés, tanto por su mayor prevalencia, como por las consecuencias deletéreas que presenta. Del mismo modo, es importante también el desafío terapéutico que conlleva, especialmente en la necesidad de terapia anticoagulante oral (TAO) para la prevención primaria y secundaria de accidentes vasculares cerebrales (ACV) y embolismos arteriales periféricos. El arsenal terapéutico de la TAO clásicamente se ha basado en los antagonistas de la vitamina K (AVK), pero desde hace unos años disponemos de los anticoagulantes de acción directa (ACODS), ofreciendo una alternativa válida en los pacientes con ERC.
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