Current situation of direct oral anticoagulants in primary care in Spain: Positioning of SEMERGEN in 2023

被引:1
作者
Polo-Garcia, J. [1 ]
Pallares-Carratala, V. [2 ]
Turegano-Yedro, M. [1 ]
Romero-Vigara, J. C. [3 ]
Prieto-Diaz, M. A. [4 ]
Cinza-Sanjurjo, S. [5 ]
机构
[1] Ctr Salud Casar Caceres, Med Familiar & Comunitaria, Caceres, Spain
[2] Univ Jaime I, Dept Med, Med Familiar & Comunitaria, Castellon de La Plana, Spain
[3] Ctr Salud Alfajarin, Med Familiar & Comunitaria, Zaragoza, Spain
[4] Ctr Salud Vallobin La Florida, Med Familiar & Comunitaria, Oviedo, Spain
[5] Inst Invest Salud Santiago De Compostela IDIS, Ctr Salud Milladoiro, Ctr Invest Biomed Red Enfermedades Cardiovascu CIB, Med Familiar & Comunitaria,Area Salud Santiago Com, Santiago De Compostela, Spain
来源
MEDICINA DE FAMILIA-SEMERGEN | 2024年 / 50卷 / 03期
关键词
Vitamin K antagonists; Direct oral anticoagulants; Atrial fibrillation; NONVALVULAR ATRIAL-FIBRILLATION; PRIMARY-HEALTH-CARE; STROKE PREVENTION; RISK STRATIFICATION; COST-EFFECTIVENESS; CHA(2)DS(2)-VASC SCORE; ANTITHROMBOTIC THERAPY; ISCHEMIC-STROKE; WARFARIN; SAFETY;
D O I
10.1016/j.semerg.2023.102136
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Oral anticoagulation is the key to reduce the risk of stroke in atrial fibrillation. Although vitamin K antagonists (VKA) have classically been used for this purpose, they have been largely overcome by direct oral anticoagulants (DOAC), as demonstrated by evidence from clinical trials, real-life and population studies. In fact, all clinical practice guidelines recommend their use preferentially over VKA. However, in Spain the prescription of DOAC is subordinated to an inspection visa that includes the clinical conditions defined in the Therapeutic Positioning Report of the Spanish Medicines Agency, and that still imposes important restrictions on their use, limiting the benefits of using DOACs in patients with atrial fibrillation (AF), and also generating inequalities between the different autonomous communities. In fact, the use of DOAC in Spain is much lower than that observed in neighboring countries. This has made that while in other countries the incidence of ischemic stroke has decreased at the population level, along with a reduction in the cost per patient with AF, in Spain this decrease has been modest. For all these reasons, and for assuring the sustainability of the health care system, we ask for the elimination of the visa so that DOAC can be prescribed according to the recommendations made by the guidelines. In addition, we are also committed to reinforce medical education and decisions made by consensus with the patient, with the primary care physician acquiring a key role in the protection of the patient with AF.
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页数:18
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