Fibrilación auricular: fisiopatología, factores de riesgo y rol de la anticoagulación oral
Atrial fibrillation: pathophysiology, risk factors and the role of the oral anticoagulatio
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Introducción: la fibrilación auricular es la arritmia cardíaca más frecuente a nivel mundial, considerándose un problema importante de salud pública dada su elevada morbimortalidad y alta carga económica asociada al ataque cerebrovascular como su principal complicación tromboembólica.Objetivo: hacer una revisión narrativa de los aspectos fisiopatológicos, factores de riesgo y de la terapia anticoagulante oral en pacientes con fibrilación auricular. Métodos: utilizando las palabras claves se realizó una revisión no sistemática de la literatura disponible, tanto en inglés como en español, en las bases de datos PubMed, Science Direct, Embase, EBSCO y MEDLINE. Se seleccionaron 68 publicaciones entre ellas guías de práctica clínica, metaanálisis, revisiones sistemáticas, ensayos clínicos y artículos originales que daban respuesta a nuestro objetivo con la mejor evidencia posible. Resultados: en el inicio y mantenimiento de la fibrilación auricular participan factores de riesgos modificables y no modificables, los cuales inciden en su fisiopatología generando tanto trastornos de la formación del impulso como trastornos de la conducción. En las últimas décadas los anticoagulantes orales directos han comprobado igual o mayor beneficio que la warfarina, con menores tasas de efectos adversos en pacientes con fibrilación auricular no valvular. Incluso, algunos estudios sugieren la extensión de uso en fibrilación auricular valvular. Sin embargo, la warfarina sigue siendo el fármaco de elección con mayor evidencia en esta última. Conclusión: la fibrilación auricular es una arritmia cuya incidencia va en aumento dado la mayor prevalencia de factores de riesgo en la población. La anticoagulación es un pilar en la prevención del ataque cerebrovascular. Debe instaurarse con un enfoque individualizado teniendo en cuenta los efectos adversos y beneficios de cada fármaco, el perfil del paciente, el riesgo de ataque cerebrovascular y el riesgo de hemorragia mediante el uso de escalas.
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