PREVENCION DE COMPLICACIONES
EN FIBRILACION ATRIAL NO
VALVULAR
Dr. Daniel Meneses
Cardiólogo Intervencionista
© Danie...
http://www.pinterest.com/
5 millones de pacientes actualmente
Para el 2050 serán 12-16 millones
FA es la arritmia mas común.
En el 2010 se diagno...
Dynamic interactions between atrial and ventricular function during atrial fibrillation (AF).
Iwasaki Y et al. Circulatio...
1. RESERVORIO DE PRESION PARA MANTENER LA PRESION DEL ATRIO IZQUIERDO
2. ORGANO SENSOR DE PRESION. 30% DE LA PRODUCCION D...
MECANISMOS DE LA FIBRILACION ATRIAL
Iwasaki Y et al. Circulation. 2011;124:2264-2274
Copyright © American Heart Associat...
Abnormalities of refractoriness (A) and conduction velocity (B) are the major determinants of
atrial fibrillation (AF) re...
Conceptual models of reentry and implications for atrial fibrillation (AF).
Iwasaki Y et al. Circulation. 2011;124:2264-2...
Types of atrial fibrillation (AF)–promoting remodeling.
Iwasaki Y et al. Circulation. 2011;124:2264-2274
Copyright © Ame...
1. RECURRENCIA PRECOZ DESPUES DE LA CARDIOVERSION
2. RESISTENCIA PROGRESIVA A LOS MEDICAMENTOS
3. PROGRESION DE FIBRILAC...
Mechanisms underlying atrial fibrillation (AF)–related thromboembolism. vWF indicates von
Willebrand factor; NOS, nitric ...
January, CT et al.
2014 AHA/ACC/HRS Atrial Fibrillation Guideline
ANTICUAGULANTES ORALES
– Inhibidores directos de Trombina:
• Ximelagatran (retirado: SPORTIF III + V
• Dabigatran: RE-L...
RE-LY
Dabigatran vs warfarina
• Evaluar la seguridad y eficacia de Dabigatran
comparado con Warfarina en pacientes con ...
RE-LY
Dabigatran vs warfarin – Study design
Randomized, phase III, open label, non-inferiority study
Non-valvular
AF p...
RE-LY:Dabigatran vs warfarina:
Conclusiones
En los pacientes con FA:
Dabigatran 110 mg bid se asocio con:
Tasa de Ictu...
Dabigatran Association with higher Risk
of Acute coronary events:
– “The robust finding that dabigatran is associated wi...
Comprehensive Late-stage
Development Programme
Area Study Facts Indication Status
Acute
Indications
12,729 patients v...
ROCKET AF
Rivaroxaban vs warfarin – Conclusiones
• Based on the prespecified primary efficacy outcome:
– A once-daily f...
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
Prevencion de complicaciones en fibrilacion atrial
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Prevencion de complicaciones en fibrilacion atrial

Complicaciones comunes de la fibrilacion atrial y su prevencion
Published on: Mar 4, 2016
Published in: Healthcare      
Source: www.slideshare.net


Transcripts - Prevencion de complicaciones en fibrilacion atrial

  • 1. PREVENCION DE COMPLICACIONES EN FIBRILACION ATRIAL NO VALVULAR Dr. Daniel Meneses Cardiólogo Intervencionista © Daniel Meneses, 2014
  • 2. http://www.pinterest.com/
  • 3. 5 millones de pacientes actualmente Para el 2050 serán 12-16 millones FA es la arritmia mas común. En el 2010 se diagnosticaron 1.2 millones de casos FA contribuye a mas de 80 000 muertes anuales El riesgo de por vida de desarrollarla en mayores de 40 años es de 1:4 En el mundo hay 600 millones de casos 26 Billones de dólares anuales son sus costos Se ha caracterizado como una nueva epidemia Gonzalez, A. (July 07, 2011). Atrial fibrillation is emerging as the new epidemic. Cardiac Rhythm News. Retrieved August 23, 2011,
  • 4. Dynamic interactions between atrial and ventricular function during atrial fibrillation (AF). Iwasaki Y et al. Circulation. 2011;124:2264-2274 Copyright © American Heart Association, Inc. All rights reserved.
  • 5. 1. RESERVORIO DE PRESION PARA MANTENER LA PRESION DEL ATRIO IZQUIERDO 2. ORGANO SENSOR DE PRESION. 30% DE LA PRODUCCION DE PEPTIDO ATRIAL NATRIURETICO 3. RESERVORIO DINAMICO DE SANGRE EN EL CICLO ATRIAL 4. CONTRACCION ACTIVA MEJORA EL LLENADO ATRIAL Y LA SISTOLE VENTRICULAR
  • 6. MECANISMOS DE LA FIBRILACION ATRIAL Iwasaki Y et al. Circulation. 2011;124:2264-2274 Copyright © American Heart Association, Inc. All rights reserved.
  • 7. Abnormalities of refractoriness (A) and conduction velocity (B) are the major determinants of atrial fibrillation (AF) reentry substrates. Iwasaki Y et al. Circulation. 2011;124:2264-2274 Copyright © American Heart Association, Inc. All rights reserved.
  • 8. Conceptual models of reentry and implications for atrial fibrillation (AF). Iwasaki Y et al. Circulation. 2011;124:2264-2274 Copyright © American Heart Association, Inc. All rights reserved.
  • 9. Types of atrial fibrillation (AF)–promoting remodeling. Iwasaki Y et al. Circulation. 2011;124:2264-2274 Copyright © American Heart Association, Inc. All rights reserved.
  • 10. 1. RECURRENCIA PRECOZ DESPUES DE LA CARDIOVERSION 2. RESISTENCIA PROGRESIVA A LOS MEDICAMENTOS 3. PROGRESION DE FIBRILACION ATRIAL PAROXISTICA A FORMAS PERSISTENTES 1. FIBROSIS LLEVA A RIGIDEZ ATRIAL Y A PERPETUACION DE LA FIBRILACION ATRIAL 2. DILATACION ATRIAL 3. REDUCCION DE LA FUNCION SISTOLICA DEL VENTRICULO IZQUIERDO
  • 11. Mechanisms underlying atrial fibrillation (AF)–related thromboembolism. vWF indicates von Willebrand factor; NOS, nitric oxide synthase; TF, tissue factor; TFPI, tissue factor pathway inhibitor; TM, thrombomodulin; TNFα, tumor necrosis factor-α; VEGF, vascular endothelial growth factor; TGF-β1, transforming growth factor-β1; F1+2, prothrombin fragment 1+2; TAT, thrombin/antithrombin complex; tPA-Ag, tissue-type plasminogen activator–antigen; tPA-PAI, tissue-type plasminogen activator/plasminogen activator inhibitor; and β-TG, β- thromboglobulin. Iwasaki Y et al. Circulation. 2011;124:2264-2274 Copyright © American Heart Association, Inc. All rights reserved.
  • 12. January, CT et al. 2014 AHA/ACC/HRS Atrial Fibrillation Guideline
  • 13. ANTICUAGULANTES ORALES – Inhibidores directos de Trombina: • Ximelagatran (retirado: SPORTIF III + V • Dabigatran: RE-LY – Inhibidores directos del factor Xa • Apixaban: AVERROES y ARISTOTLE • Edoxaban: ENGAGE AF-TIMI 48 (en curso) • Rivaroxaban: ROCKET AF
  • 14. RE-LY Dabigatran vs warfarina • Evaluar la seguridad y eficacia de Dabigatran comparado con Warfarina en pacientes con fibrilacion atrial no valvula para prevencion de ictus o embolismo sistemico
  • 15. RE-LY Dabigatran vs warfarin – Study design Randomized, phase III, open label, non-inferiority study Non-valvular AF plus at least 1 additional risk factor* N=18,113 • Primary efficacy: composite of all-cause stroke or systemic embolism • Major safety: major bleeding • Excludes: patients with severe renal impairment (CrCl ≤30 ml/min) Connolly SJ et al. N Engl J Med 2009;361:1139−1151 Dabigatran 110 mg bid Dabigatran 150 mg bid Open-label warfarin (target INR range 2–3) R Follow-up End of treatment *Previous stroke or TIA , NYHA ≥Class II HF, LVEF <40%, age ≥75 years, age ≥65 with either a history of coronary artery disease, hypertension or diabetes mellitus
  • 16. RE-LY:Dabigatran vs warfarina: Conclusiones En los pacientes con FA: Dabigatran 110 mg bid se asocio con: Tasa de Ictus/embolismo sitemico similar a warfarina Una menor tasa de sangrado mayor Dabigatran 150 mg bid se asocio con: Una tasa de ictus/embolismo sistemico menor que Warfarina Una tasa similar de sangrado mayor
  • 17. Dabigatran Association with higher Risk of Acute coronary events: – “The robust finding that dabigatran is associated with increased rates of MI is alarming and emphasizes the need for continued critical appraisal of new drugs after phase 3 trials…….” – “New drugs have dangers that may become apparent long after clinical trials have given way to ….daily clinical drug use.” The authors clearly see an alarming signal for an increased rate of MI with dabigatran which is also recognized by the annotator and the editor. However, there is also some general concern expressed with regard to the unreflected use of new drugs. Hence, our communication on ‘Xarelto’ must ensure that we differentiate by data and by market behaviour from these dabigatran related issues. Uchino K et al. Arch Intern Med. 2012 Mar 12;172(5):397-402
  • 18. Comprehensive Late-stage Development Programme Area Study Facts Indication Status Acute Indications 12,729 patients vs. standard therapy (enoxaparin) Launched in >85 countries 8,101 patients vs. standard therapy (enoxaparin) Completed Chronic Indications 4,832 patients vs. standard therapy (enoxaparin & warfarin) Completed 14,264 patients vs. standard therapy (warfarin) Completed 15,526 patients in addition to standard therapy VTE prevention after orthopedic surgery VTE prevention in medically ill patients VTE treatment and secondary prevention Stroke prevention in atrial fibrillation Secondary prevention ACS Completed
  • 19. ROCKET AF Rivaroxaban vs warfarin – Conclusiones • Based on the prespecified primary efficacy outcome: – A once-daily fixed-dose regimen of rivaroxaban was non-inferior to warfarin for prevention of stroke or non-CNS systemic embolism – Rivaroxaban was superior to warfarin while patients were taking study drug – A sensitivity analysis in the ITT population that followed all patients in the trial until completion showed a benefit for rivaroxaban, but did not reach superiority • Safety: – Similar overall incidence of bleeding and adverse events – Increase in gastrointestinal bleeds but fewer intracranial haemorrhages and less fatal bleeding with rivaroxaban • Implication: – Rivaroxaban, administered once daily, has demonstrated non-inferiority to warfarin in the prevention of stroke or systemic embolism, with similar overall bleeding and fewer intracranial haemorrhages and fatal bleeds Patel MR et al. N Engl J Med 2011;365:883–891

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