Avances en la prevención de eventos tromboembólicos en pacientes con fibrilación auricular

Atrial fibrillation is the most common sustained arrhythmia inclinical practice and is associated to thromboembolic complications. Anticoagulation withvitamin K antagonists is clearly useful to reduce the incidence of emboli, but associated withimportant limitations. Therefore, there is an active search for medications that are moreeffective and simpler to prescribe and manage. Synthetic pentasaccharides of heparin such asidraparinux for parenteral use, showed promising results. Direct inhibitors of thrombin werealso useful for the prevention of thromboembolism. However, they were withdrawn from themarket due to potentially fatal adverse reactions. Other area of investigation has been theeffectiveness of the combination of antiplatelet agents such as aspirin and clopidrogel. Althoughthis combination is attractive, results of clinical trials must be awaited to have an opinionabout its real usefulness. Finally, left atrial appendage transcatheter occlusion (PLAATO) is aneffective and reasonably safe method for patients with contraindications for anticoagulation orthose that continue to embolize despite well prescribed anticoagulation. The long term results ofthis intervention must also be awaited (Rev Med Chile 2007; 135: 1048-55).(