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

Autor:	Polo-García J; Medicina Familiar y Comunitaria, Centro de Salud Casar de Cáceres, Casar de Cáceres, Cáceres, España., Pallares-Carratalá V; Medicina Familiar y Comunitaria, Departamento de Medicina, Universidad JaimeI, Castellón, España. Electronic address: pallares.vic@gmail.com., Turegano-Yedro M; Medicina Familiar y Comunitaria, Centro de Salud Casar de Cáceres, Casar de Cáceres, Cáceres, España., Romero-Vigara JC; Medicina Familiar y Comunitaria, Centro de Salud Alfajarín, Alfajarín, Zaragoza, España., Prieto-Díaz MA; Medicina Familiar y Comunitaria, Centro de Salud Vallobín-La Florida, Oviedo, España., Cinza-Sanjurjo S; Medicina Familiar y Comunitaria, Centro de Salud Milladoiro, Área de Salud de Santiago de Compostela. Instituto de Investigación en Salud de Santiago de Compostela (IDIS). Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Santiago de Compostela, La Coruña, España.
Jazyk:	Spanish; Castilian
Zdroj:	Semergen [Semergen] 2024 Apr; Vol. 50 (3), pp. 102136. Date of Electronic Publication: 2023 Dec 05.
DOI:	10.1016/j.semerg.2023.102136
Abstrakt:	Oral anticoagulation is the key to reduce the risk of stroke in atrial fibrillation. Although vitaminK 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. (Copyright © 2023 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)
Databáze:	MEDLINE
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