**Author details**

Raúl Alcaraz1,<sup>⋆</sup> and José Joaquín Rieta2

<sup>⋆</sup> Address all correspondence to: raul.alcaraz@uclm.es

1Innovation in Bioengineering Research Group, University of Castilla-La Mancha, Cuenca, Spain

2Biomedical Synergy, Universidad Politécnica de Valencia, Gandía, Spain

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**Section 4**

**Anticoagulation Therapy**


**Anticoagulation Therapy**

24 Atrial Fibrillation

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**Chapter 9**

**New Oral Anticoagulants in Atrial Fibrillation**

Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice with a strong impact on public health*.* The prevalence in the general population is 0.4% and their incidence increases markedly with age to reach 4-5% in patients over 65 years and 9% in patients older than 80 years [1]. The main complication associated with this disease is the development of an embolic event, peripheral or cerebral, strokes being caused by the AF the most serious and worse prognosis. The risk that a patient suffers a stroke with AF is related to the presence of other cardioembolic risk factors: hypertension, diabetes mellitus, heart failure or left ventricular systolic dysfunction, moderately severe, age over 75 years, female, vascular disease or stroke have shown a previous cerebral (transient or establish‐ ed). These risk factors are reflected in the scales CHADS2 or CHA2DS2-VASC used today to

In the management of patients with AF, the most important to improve prognosis is correct indication of anticoagulant therapy. For over 60 years using vitamin K antagonists (VKAs), especially warfarin and acenocoumarol, have been shown in several studies a reduction of 70% risk of stroke in AF patients correctly anticoagulated compared with only 22% reduc‐ tion of antiplatelet drugs, or a nonsignificant 19% reduction with acetylsalicylic acid. Thus, oral anticoagulants (OACs) are recommended in AF patients at moderate-high risk for sroke and tromboembolism [2]. The VKAs are drugs with proven efficacy, specific antidote in case of bleeding, possibility of discontinuing medication urgently and low cost. However, VKAs have limitations that affect the quality of life of patients and increase morbidity: narrow therapeutic window (International normalized ratio, INR 2.0-3.0) [3], unpredictable re‐ sponse, systematic control of bleeding, frequent dose adjustments and numerous food and drug interactions. Also, scenarios such as intercurrent infections and other medical condi‐ tions can also modify the values of the INR [4]. These results indicate that it is important to

> © 2013 Cid-Conde and López-Castro; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is

and reproduction in any medium, provided the original work is properly cited.

© 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,

Lucía Cid-Conde and José López-Castro

http://dx.doi.org/10.5772/53614

evaluate this type of patient.

properly cited.

**1. Introduction**

Additional information is available at the end of the chapter
