Describir las características clínicas y el manejo de pacientes con fibrilación auricular no valvular (FANV) tratados con anticoagulantes orales de acción directa (ACOD) de acuerdo a quién inicia su prescripción: el médico de atención primaria (AP) o el especialista.

Se compararon 2 estudios observacionales, transversales y multicéntricos. El estudio SILVER-AP se realizó en aquellas comunidades autónomas en las que el médico de AP podía prescribir ACOD y el estudio BRONCE-AP en aquellas comunidades autónomas en las que el médico de AP debía derivar al especialista para tal fin. Se incluyeron pacientes diagnosticados de FANV con riesgo de ictus o embolia sistémica que estuviesen en tratamiento crónico con anticoagulantes, que hubiesen modificado su pauta terapéutica y que actualmente estuviesen en tratamiento con un ACOD durante al menos 3meses.

Se incluyeron un total de 1.036 pacientes (790 provenientes del estudio SILVER-AP y 246 del BRONCE-AP). En comparación con el estudio BRONCE-AP, los pacientes incluidos en el SILVER-AP eran mayores, tenían más comorbilidades y el riesgo tromboembólico y hemorrágico era más elevado (CHA2DS2-VASc 4,3±1,6 vs. 3,8±1,8; p<0,001; HAS-BLED 2,1±0,8 vs. 1,8±1,0; p<0,001). El cumplimiento terapéutico fue elevado, al igual que la satisfacción con el tratamiento. Las dosis bajas de ACOD se emplearon frecuentemente, en especial con dabigatrán.

Los pacientes en los que el médico de AP puede prescribir ACOD tienen un peor perfil clínico, con un mayor riesgo tromboembólico y de hemorragias que aquellos casos en los que debe derivar al especialista.

To determine the clinical characteristics and management of patients with non-valvular atrial fibrillation (NVAF) treated with direct oral anticoagulants (DOAC) according to who initiates their prescription, the Primary Care (PC) physician or referring the patient to a specialist.

Two observational, cross-sectional and multicentre studies were compared for this purpose. The SILVER-AP study was performed in those autonomous communities in which the PC physician can prescribe DOAC directly, and the BRONCE-AP study in those autonomous communities in which the PC physician has to refer the patient to the specialist to start treatment with DOAC. Patients on chronic treatment with anticoagulants, in whom therapy was changed, and those that were on current treatment with DOAC for at least 3months, were included.

A total of 1,036 patients (790 from SILVER-AP study and 246 from BRONCE-AP study) were included. Compared with the BRONCE-AP study, those patients included in SILVER-AP were older and had more comorbidities, as well as a higher thromboembolic and haemorrhagic risk (CHA2DS2-VASc 4.3±1.6 vs. 3.8±1.8; P<.001; HAS-BLED 2.1±0.8 vs. 1.8±1.0; P<.001). Therapeutic adherence and satisfaction with treatment were high. Low doses of DOAC were frequently prescribed, particularly with dabigatran.

Those patients in whom the PC physician can prescribe DOAC directly have a worse clinical profile, as well as a higher thromboembolic and haemorrhagic risk than those patients in whom the PC physician has to refer to the specialist.