Llisterri Caro J L, Cinza-Sanjurjo S, Polo Garcia J, Prieto Díaz M A
Médico de Familia, Fundación de Investigación SEMERGEN, Madrid, España.
Medicina Familiar y Comunitaria, Centro de Salud Porto do Son, Porto do Son, A Coruña, España.
Semergen. 2019 Sep;45(6):413-429. doi: 10.1016/j.semerg.2019.06.002. Epub 2019 Jul 19.
The direct-acting oral anticoagulants (DOACs) are drugs that have been shown to have a safety profile superior to the vitaminK antagonists (VKA). The prescribing of DOACs in Spain is subject to approval in the form of an inspection visa. This sets out the clinical conditions defined in the Spanish Medicines Agency Therapeutic Positioning Report (TPR) of 2013, updated in 2016. These recommendations do not coincide with those of the European Cardiology Society (2016), restricting the use of DOACs to a second-line treatment in the majority of cases. Furthermore, this TPR is applied differently in the Regional Autonomous Communities and even in different health areas. This leads to a wide variation in the prescribing conditions, causing territorial inequalities in accessibility to these drugs by patients. The removal of the visa, and the appropriateness of the prescription to the recommendations of the Clinical Practice guidelines are key aspects to neutralise the current administrative and clinical barriers for the efficient use of DOACs in Primary Care. SEMERGEN supports the boosting of the clinical training and alliance with the patients in order to promote awareness and knowledge of atrial fibrillation.
直接口服抗凝剂（DOACs）已被证明其安全性优于维生素K拮抗剂（VKA）。在西班牙，DOACs的处方须以检查签证的形式获得批准。这规定了西班牙药品管理局2013年治疗定位报告（TPR）中所定义的临床条件，该报告于2016年更新。这些建议与欧洲心脏病学会（2016年）的建议不一致，在大多数情况下将DOACs的使用限制为二线治疗。此外，该TPR在自治区甚至不同的卫生领域应用方式不同。这导致处方条件差异很大，造成患者获取这些药物的地域不平等。取消签证以及使处方符合临床实践指南的建议是消除目前在基层医疗中有效使用DOACs的行政和临床障碍的关键方面。西班牙初级保健医生协会支持加强临床培训并与患者建立联盟，以提高对房颤的认识和了解。
