Seguridad y eficacia de los anticoagulantes orales directos y warfarina en pacientes adultos con fibrilación auricular, valvulopatías y síndrome antifosfolípido. Revisión bibliográfica

Abstract

Background: Oral anticoagulants are drugs used to prevent fatal complications of cardiovascular diseases. Currently, direct oral anticoagulants (DOACs) are a new alternative to warfarin; however, more research is required to be able to replace it, because the cost of DOACs is 8 to 16 times higher. Therefore, it is important to describe current evidence on the safety and efficacy of DOACs and warfarin in adult patients with atrial fibrillation (AF), valvular heart disease, and antiphospholipid syndrome (APS). Methods: Narrative, bibliographic, qualitative review including a total of 13 scientific studies, 5 cohorts, 4 meta-analyses, 3 systematic reviews and 1 case and control, selected from Pubmed database, which met suitable methodological criteria. Results: Of the 13 selected articles, eight focused on AF, two on valvular heart disease, and three on APS. Search results revealed that DOACs had a lower risk of stroke, systemic embolism, and hemorrhage in AF and valvular heart disease, while in APS there was a lower risk of arterial and / or recurrent thrombosis after using warfarin. Conclusions: In patients with AF and valvular heart disease, DOACs were reported to be more effective and safer than warfarin, while in APS, warfarin was more effective and safer. Apixaban was the drug of choice for AF; it could not be determined which DOC was the first choice for valvular heart disease; warfarin was the oral anticoagulant for APS.