array:21 [
  "pii" => "S2254887415000144"
  "issn" => "22548874"
  "doi" => "10.1016/j.rceng.2014.11.005"
  "estado" => "S300"
  "fechaPublicacion" => "2015-04-01"
  "aid" => "1087"
  "copyrightAnyo" => "2015"
  "documento" => "simple-article"
  "subdocumento" => "crp"
  "cita" => "Rev Clin Esp. 2015;215:171-81"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 114
    "formatos" => array:2 [
      "HTML" => 108
      "PDF" => 6
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:18 [
      "pii" => "S0014256514004470"
      "issn" => "00142565"
      "doi" => "10.1016/j.rce.2014.11.024"
      "estado" => "S300"
      "fechaPublicacion" => "2015-04-01"
      "aid" => "1087"
      "copyright" => "Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI)"
      "documento" => "simple-article"
      "subdocumento" => "crp"
      "cita" => "Rev Clin Esp. 2015;215:171-81"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 1206
        "formatos" => array:2 [
          "HTML" => 1094
          "PDF" => 112
        ]
      ]
      "es" => array:12 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Actualizaci&#243;n Cl&#237;nica</span>"
        "titulo" => "Tratamiento antitromb&#243;tico en el paciente anciano con fibrilaci&#243;n auricular"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "171"
            "paginaFinal" => "181"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Antithrombotic Treatment in Elderly Patients with Atrial Fibrillation"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "C&#46; Su&#225;rez Fern&#225;ndez, M&#46; Camafort, J&#46;M&#46; Cepeda Rodrigo, J&#46; D&#237;ez-Manglano, F&#46; Formiga, A&#46; Pose Reino, G&#46; Tiberio, J&#46;M&#46; Mostaza"
            "autores" => array:9 [
              0 => array:2 [
                "nombre" => "C&#46;"
                "apellidos" => "Su&#225;rez Fern&#225;ndez"
              ]
              1 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Camafort"
              ]
              2 => array:2 [
                "nombre" => "J&#46;M&#46;"
                "apellidos" => "Cepeda Rodrigo"
              ]
              3 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "D&#237;ez-Manglano"
              ]
              4 => array:2 [
                "nombre" => "F&#46;"
                "apellidos" => "Formiga"
              ]
              5 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Pose Reino"
              ]
              6 => array:2 [
                "nombre" => "G&#46;"
                "apellidos" => "Tiberio"
              ]
              7 => array:2 [
                "nombre" => "J&#46;M&#46;"
                "apellidos" => "Mostaza"
              ]
              8 => array:1 [
                "colaborador" => "en nombre del Grupo de Trabajo de Riesgo Vascular de la SEMI"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2254887415000144"
          "doi" => "10.1016/j.rceng.2014.11.005"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887415000144?idApp=WRCEE"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256514004470?idApp=WRCEE"
      "url" => "/00142565/0000021500000003/v1_201504010035/S0014256514004470/v1_201504010035/es/main.assets"
    ]
  ]
  "itemAnterior" => array:18 [
    "pii" => "S2254887414001465"
    "issn" => "22548874"
    "doi" => "10.1016/j.rceng.2014.12.001"
    "estado" => "S300"
    "fechaPublicacion" => "2015-04-01"
    "aid" => "1055"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
    "documento" => "article"
    "subdocumento" => "fla"
    "cita" => "Rev Clin Esp. 2015;215:156-64"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 162
      "formatos" => array:2 [
        "HTML" => 161
        "PDF" => 1
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Prevalence of depression in type 2 diabetes mellitus"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "156"
          "paginaFinal" => "164"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Prevalencia de la depresi&#243;n en la diabetes mellitus tipo 2"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 955
              "Ancho" => 1609
              "Tamanyo" => 55356
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Prevalence of depression in patients with type 2 diabetes mellitus&#44; as a function of age and sex&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46;L&#46; Rodr&#237;guez Calv&#237;n, A&#46; Zapatero Gaviria, M&#46;D&#46; Mart&#237;n R&#237;os"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "J&#46;L&#46;"
              "apellidos" => "Rodr&#237;guez Calv&#237;n"
            ]
            1 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Zapatero Gaviria"
            ]
            2 => array:2 [
              "nombre" => "M&#46;D&#46;"
              "apellidos" => "Mart&#237;n R&#237;os"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S001425651400410X"
        "doi" => "10.1016/j.rce.2014.10.010"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S001425651400410X?idApp=WRCEE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887414001465?idApp=WRCEE"
    "url" => "/22548874/0000021500000003/v1_201504010033/S2254887414001465/v1_201504010033/en/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Clinical up-date</span>"
    "titulo" => "Antithrombotic treatment in elderly patients with atrial fibrillation"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "171"
        "paginaFinal" => "181"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "C&#46; Su&#225;rez Fern&#225;ndez, M&#46; Camafort, J&#46;M&#46; Cepeda Rodrigo, J&#46; D&#237;ez-Manglano, F&#46; Formiga, A&#46; Pose Reino, G&#46; Tiberio, J&#46;M&#46; Mostaza"
        "autores" => array:9 [
          0 => array:4 [
            "nombre" => "C&#46;"
            "apellidos" => "Su&#225;rez Fern&#225;ndez"
            "email" => array:1 [
              0 => "csuarezf&#64;salud&#46;madrid&#46;org"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Camafort"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "J&#46;M&#46;"
            "apellidos" => "Cepeda Rodrigo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "J&#46;"
            "apellidos" => "D&#237;ez-Manglano"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "F&#46;"
            "apellidos" => "Formiga"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "Pose Reino"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "aff0030"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "G&#46;"
            "apellidos" => "Tiberio"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">g</span>"
                "identificador" => "aff0035"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "J&#46;M&#46;"
            "apellidos" => "Mostaza"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">h</span>"
                "identificador" => "aff0040"
              ]
            ]
          ]
          8 => array:1 [
            "colaborador" => "on behalf of Grupo de Trabajo de Riesgo Vascular de la SEMI"
          ]
        ]
        "afiliaciones" => array:8 [
          0 => array:3 [
            "entidad" => "Hospital Universitario de La Princesa&#44; Grupo de Riesgo Vascular de la SEMI&#44; Madrid&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Hospital Clinic de Barcelona&#44; Grupo de Riesgo Vascular de la SEMI&#44; Barcelona&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Hospital Vega Baja de Orihuela&#44; Grupo de Riesgo Vascular de la SEMI&#44; Orihuela&#44; Alicante&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Hospital Royo Villanova&#44; Grupo de Riesgo Vascular de la SEMI&#44; Zaragoza&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Hospital Universitari de Bellvitge&#44; Grupo de Riesgo Vascular de la SEMI&#44; Hospitalet de Llobregat&#44; Barcelona&#44; Spain"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
          5 => array:3 [
            "entidad" => "Complexo Hospitalario Universitario de Santiago&#44; Grupo de Riesgo Vascular de la SEMI&#44; Santiago de Compostela&#44; Spain"
            "etiqueta" => "f"
            "identificador" => "aff0030"
          ]
          6 => array:3 [
            "entidad" => "Hospital Virgen del Camino&#44; Grupo de Riesgo Vascular de la SEMI&#44; Pamplona&#44; Spain"
            "etiqueta" => "g"
            "identificador" => "aff0035"
          ]
          7 => array:3 [
            "entidad" => "Hospital Carlos III&#44; Grupo de Riesgo Vascular de la SEMI&#44; Madrid&#44; Spain"
            "etiqueta" => "h"
            "identificador" => "aff0040"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Tratamiento antitromb&#243;tico en el paciente anciano con fibrilaci&#243;n auricular"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Case report</span><p id="par0005" class="elsevierStylePara elsevierViewall">An 83-year-old man&#44; with arterial hypertension and diabetes&#44; experienced a hip fracture 2 months ago due to an accidental fall&#44; which was treated with a total hip prosthesis&#46; The patient was treated with 50<span class="elsevierStyleHsp" style=""></span>mg&#47;day of losartan&#44; 5<span class="elsevierStyleHsp" style=""></span>mg&#47;day of amlodipine and 850<span class="elsevierStyleHsp" style=""></span>mg&#47;day of metformin&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">During a routine examination&#44; the attending physician detected atrial fibrillation of uncertain origin&#46; The patient was asymptomatic from a cardiology standpoint&#46; The physical examination was anodyne&#44; although arrhythmia was detected in the auscultation&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Due to the recent fall&#44; the decision was made to anticoagulate the patient with acetylsalicylic acid &#40;100<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#46; Three months later&#44; the patient was admitted to the hospital with a stroke&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">The clinical problem</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Epidemiological aspects</span><p id="par0020" class="elsevierStylePara elsevierViewall">Atrial fibrillation &#40;AF&#41; is the most common type of arrhythmia in clinical practice&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">1</span></a> The Anticoagulation and Risk Factors in Atrial Fibrillation &#40;ATRIA&#41; study&#44; conducted in the United States&#44; observed that AF affects approximately 1&#37; of the general population&#44; although this percentage increases with age from 0&#46;1&#37; in participants younger than 55 years to 9&#37; in those participants aged 80 years or more&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">2</span></a> The same trend has been observed in Europe&#59; it has been estimated that the prevalence of AF is less than 1&#37; in participants aged 55&#8211;59 years and approximately 18&#37; in those who are at least 85 years of age&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">3</span></a> The VAL-FAAP study analyzed approximately 120&#44;000 participants treated in primary care in Spain&#46; The prevalence of AF was 6&#46;1&#37;&#44; a figure that increased with age from somewhat less than 1&#37; in participants younger than 50 years to 17&#46;6&#37; for those 80 years or older&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">4</span></a> In the Observation of Atrial Fibrillation and Coronary Disease in Spain &#40;<span class="elsevierStyleItalic">Observaci&#243;n de Fibrilaci&#243;n Auricular y Enfermedad Coronaria en Espa&#241;a</span>&#44; OFRECE&#41; study that analyzed participants 40 years of age and older treated in primary care&#44; the prevalence of AF was 4&#46;4&#37; and progressively increased starting at 60 years of age&#44; reaching 17&#46;7&#37; in those older than 80 years&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">5</span></a> In the DARIOS study that analyzed 6 population-based studies&#44; the prevalence of AF was 1&#46;5&#37;&#44; a figure that increased with the age&#44; up to 6&#46;3&#37; in those older than 75 years&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">6</span></a> Data from the ESFINGE study show that a third of patients older than 70 years hospitalized in the national departments of internal medicine have AF&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The prevalence of AF not only increases with age but also with the presence of other associated comorbidities&#44; such as ischemic heart disease and heart failure&#44; conditions that are also more prevalent in advanced ages&#46;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">8&#44;9</span></a> Due to the progressive aging of the population&#44; both the prevalence and incidence of AF has increased markedly in recent years&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">1&#44;10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">AF increases the risk of stroke by up to 5-fold&#46; More than 15&#37; of stroke episodes are due to AF &#40;36&#37; in individuals older than 80 years&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">9</span></a> Additionally&#44; stroke associated with AF&#44; when compared with stroke unrelated to AF&#44; has higher morbidity and mortality and causes more sequela and hospitalizations&#44; especially in the elderly&#46;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">11&#8211;14</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In the elderly population&#44; the treatment objectives for patients with AF should be focused on preventing complications related to the presence of this arrhythmia&#44; especially stroke&#44; as well as on improving quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">12</span></a> In this context&#44; anticoagulation plays a fundamental role&#46; However&#44; it is particularly important with the elderly population to balance the risk of both stroke and bleeding&#44; given that both are increased in these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">12</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The objective of this update was to review the specific comments by the clinical practice guidelines on antithrombotic treatment in elderly patients with nonvalvular AF &#40;NVAF&#41;&#46; It is important to emphasize that the definition of the elderly patient has changed over time&#46; Although in the past elderly patients were considered those aged 65 years or older&#44; the various current clinical practice guidelines and the studies performed with direct oral anticoagulants have raised this cutoff to 75 years&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Clinical profile of elderly patients with atrial fibrillation</span><p id="par0045" class="elsevierStylePara elsevierViewall">The management of elderly patients with AF is complex due to&#44; among other things&#44; their considerable number of comorbidities&#44; which often result in polymedication&#46; Thus&#44; it has been observed among patients with hypertension and chronic ischemic heart disease that those with AF are older and more often present diabetes&#44; left ventricular hypertrophy&#44; heart failure&#44; peripheral arterial disease&#44; renal failure and stroke&#44; when compared with those in sinus rhythm&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">9</span></a> Moreover&#44; it appears that patients with AF have an increased risk of dementia&#44; particularly those with a history of stroke&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">15</span></a> In fact&#44; there are various peculiarities in the elderly that confer a condition of frailty&#46; Physical and mental abnormalities are common&#44; especially cognitive and mood disorders&#44; risk of falls&#44; malnutrition and social dependence&#44; which have a significant impact on the management of these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">12</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Advanced age is itself an independent predictor of both stroke and mortality after the stroke&#44; as well as the risk of bleeding&#46;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">16&#8211;20</span></a> This aspect is considered in the risk scales&#46; On the CHADS<span class="elsevierStyleInf">2</span> scale&#44; an age &#8805;75 years scores 1 point&#44; reinforcing the increase in risk with increasing age&#46; For the CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc scale&#44; an age between 65 and 74 years is awarded 1 point&#44; increasing to 2 for ages &#62;75 years&#46; In terms of the risk of bleeding&#44; an age &#62;65 years scores 1 point on the HAS-BLED &#40;Hypertension&#44; Abnormal Renal&#47;Liver Function&#44; Stroke&#44; Bleeding History or Predisposition&#44; Labile INR&#44; Elderly&#44; Drugs&#47;Alcohol Concomitantly&#41; scale&#46;<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">17&#8211;20</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Consequently&#44; taking into account the above described determinants&#44; it is especially important for elderly patients to not only balance the risk of stroke with that of hemorrhage but also to assess the possibility of properly taking medication&#44; the availability of a caregiver&#44; the social support&#44; etc&#46;<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">12&#44;21</span></a> In principle&#44; except when the patient has a high risk of bleeding&#44; the considerable majority of elderly patients with NVAF should undergo permanent anticoagulation&#46; Nevertheless&#44; the Birmingham Atrial Fibrillation Treatment of the Aged &#40;BAFTA&#41; study found no evidence that&#44; when compared with acetylsalicylic acid&#44; anticoagulation provided clinically relevant protection against cognitive impairment in patients after 33 months of treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">22</span></a> A decision algorithm has recently been proposed for better profiling geriatric patients with NVAF who will most benefit from treatment with vitamin K antagonists&#46; The algorithm includes 6 items &#40;previous bleeding with vitamin K antagonists&#44; degree of autonomy&#44; mini mental state examination &#91;MMSE&#93; score&#44; risk of falls and comorbidity index&#41;&#46; Each variable has a score &#40;0&#44; 0&#46;5 and 1 point&#41; according to the intensity &#40;mild&#44; moderate or high&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">23</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes the peculiarities of AF in this age group&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Strategies and evidence</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Anticoagulation with vitamin K antagonists for elderly patients</span><p id="par0065" class="elsevierStylePara elsevierViewall">Traditionally&#44; anticoagulation for patients with AF has been performed with vitamin K antagonists&#46; In fact&#44; it has been shown that anticoagulant therapy with vitamin K antagonists is an effective treatment for the prevention of stroke and thromboembolism when compared with antiplatelet agents&#44; including acetylsalicylic acid&#46;<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">24&#44;25</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Anticoagulant treatment with vitamin K antagonists is also beneficial for the elderly population&#46; The BAFTA study compared warfarin treatment with acetylsalicylic acid treatment &#40;75<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#44; with approximately 1000 participants 75 years of age or older with AF who were followed-up for a mean time of 2&#46;7 years&#46; The warfarin treatment was associated with a significant reduction &#40;52&#37;&#41; in the risk of fatal or debilitating stroke&#44; intracranial hemorrhage and clinically significant arterial embolism&#44; with no significant differences in the risk of extracranial hemorrhage&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">26</span></a> Subsequent studies have confirmed the benefits of anticoagulation in this population&#46;<a class="elsevierStyleCrossRefs" href="#bib0405"><span class="elsevierStyleSup">27&#44;28</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Although it is certain that the risk of bleeding is increased in elderly patients&#44;<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">19&#44;29</span></a> permanent anticoagulation is indicated for the majority of elderly patients with AF&#46; However&#44; the reality is that a significant number of patients who have an indication for anticoagulation do not receive it&#44; precisely because of the fear of bleeding&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">9&#44;30&#8211;34</span></a> In a study performed with approximately 600 participants with NVAF&#44; only 34&#37; of the participants were treated with anticoagulation at discharge&#46; This percentage was even lower for the more elderly participants &#40;42&#37; among individuals aged 65&#8211;75 years and 29&#37; for those older than 75 years&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">31</span></a> In addition to bleeding&#44; the factors that promote this situation include falls&#44; which should never be an absolute contraindication for anticoagulation&#46; However&#44; given that frequent falls in elderly patients with AF are associated with higher mortality&#44; in the patient group with a lower CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc score &#40;e&#46;g&#46;&#44; 0&#8211;3&#41;&#44; the decision to provide anticoagulation therapy to the patient should be made by carefully assessing the risk&#47;benefit ratio&#46;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">35</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Vitamin K antagonists have certain limitations&#44; such as their narrow therapeutic window&#44; variable anticoagulant response&#44; interactions with food and other drugs and a slow start and end of action&#44; which require the implementation of periodic checkups and frequent dosage adjustments &#40;more common in the elderly&#41;&#46; These limitations undoubtedly contribute to the underutilization of these drugs in clinical practice&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">4</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Direct oral anticoagulants in elderly patients</span><p id="par0085" class="elsevierStylePara elsevierViewall">Direct oral anticoagulants &#40;dabigatran&#44; rivaroxaban&#44; apixaban and&#44; more recently&#44; edoxaban&#41; have at least a similar efficacy as warfarin in preventing stroke and systemic embolism but have a better safety profile&#44; mainly due to the lower risk of intracranial hemorrhage for patients with NVAF&#46; In addition to having predictable kinetics and a broad therapeutic window&#44; these anticoagulants can be prescribed at a fixed dosage&#44; without the need for periodic checkups&#46;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">36</span></a> Clinical trials specifically designed to assess the safety and efficacy of these drugs in elderly populations have unfortunately not been performed&#46; However&#44; in recent years&#44; various subanalyses have been published on the safety and efficacy of direct oral anticoagulants by age&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In the RE-LY study that compared dabigatran to warfarin&#44; both dabigatran dosages had a lower risk of both intracranial and extracranial bleeding in the participants younger than 75 years&#46; The patients aged 75 years or older had less frequent intracranial bleeding&#44; but the extracranial bleeding was equal or more frequent&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">37</span></a> Given that the elimination of dabigatran is performed mainly by the kidneys and that the elderly frequently have renal failure&#44; close monitoring of renal function is important for these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">38</span></a> Although the standard recommended dosage for dabigatran is 150<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h&#44; it is recommended that the dosage be reduced to 110<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h for patients aged 80 years or older&#46; For patients aged 75&#8211;80 years or with moderate renal failure&#44; the dosage is selected depending on the risk of stroke&#47;bleeding&#46; In the ROCKET-AF study &#40;An Efficacy and Safety Study of Rivaroxaban With Warfarin for the Prevention of Stroke and Non-Central Nervous System Systemic Embolism in Patients With Non-Valvular Atrial Fibrillation&#41; that compared warfarin to rivaroxaban&#44; the efficacy &#40;risk of stroke and systemic embolism&#41; and safety &#40;risk of major bleeding&#41; of rivaroxaban were consistent with the overall study results&#44; regardless of age&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">39</span></a> In the Apixaban for the Prevention of Stroke in Subjects With Atrial Fibrillation &#40;ARISTOTLE&#41; study&#44; apixaban was more effective in reducing the risk of stroke and mortality&#44; with fewer major bleeding episodes&#44; total bleeding episodes and intracranial bleeding episodes&#44; regardless of age&#44; including with patients aged 80 years or older&#46;<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">40</span></a> In a recent meta-analyses of patients aged 75 years or older enrolled in clinical trials performed with rivaroxaban&#44; apixaban and dabigatran&#44; the direct oral anticoagulants as a whole were more effective than standard treatment in the prevention of stroke and systemic embolism&#46;<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">41</span></a> In the ENGAGE AF-TIMI 48 study&#44; both edoxaban dosages were noninferior to warfarin with respect to preventing stroke and systemic embolism but had fewer major bleeding episodes&#44; regardless of age &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">42</span></a><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows how the dosage adjustments for dabigatran&#44; rivaroxaban and apixaban should be performed for patients with NVAF&#44; depending on age&#44; renal function and weight&#46;<a class="elsevierStyleCrossRefs" href="#bib0485"><span class="elsevierStyleSup">43&#8211;45</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Controversy and issues to be resolved</span><p id="par0095" class="elsevierStylePara elsevierViewall">Despite the recent proliferation of guidelines that&#44; to various degrees&#44; refer to the elderly&#44; the evidence in this population group is scarce&#44; and there are a number of unresolved issues that are frequently faced by clinicians in their daily practice&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">A number of these issues are examined below&#46; The major advantage of direct oral anticoagulants is the reduction in intracranial hemorrhage&#46; In addition&#44; there are data from neuroimaging tests &#40;e&#46;g&#46;&#44; microinfarctions&#44; leukoaraiosis&#44; and microhemorrhages&#41; that are associated with an increased risk of intracranial hemorrhage&#44; particularly in cases where there is a history of ischemic stroke&#46; Given this&#44; should a brain CT scan&#47;MRI be performed for elderly patients with an indication of anticoagulation&#44; due to their greater risk of bleeding and high prevalence of the previously mentioned lesion&#63; What type of antithrombotic treatment is the treatment of choice for an elderly patient with a history of frequent falls&#63; In what way does cognitive impairment determine the indication and type of antithrombotic treatment in elderly patients with AF&#63; How often and under what circumstances should renal function be monitored in elderly patients undergoing anticoagulation&#63; Under what circumstances is the temporary or definitive withdrawal of anticoagulation recommended for the elderly&#63; How should antithrombotic treatment be managed for patients with a high risk of gastrointestinal bleeding&#63; How does polypharmacy and poorer treatment compliance influence the choice of anticoagulant treatment for the elderly&#63; How should weight and frailty affect the dosage of direct oral anticoagulants in elderly patients&#63; Are there sufficient data on their safety and efficacy to recommend direct oral anticoagulants to very elderly patients&#63; The answers to these questions will probably only be found when sufficient experience in the real world is available&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">What do the clinical practice guidelines say on this matter&#63;</span><p id="par0105" class="elsevierStylePara elsevierViewall">In recent years&#44; various clinical practice guidelines have been published on managing patients with AF&#46; Although the recommendations are generally given regardless of age&#44; a number have specific comments on elderly populations&#44; which we will review below&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">In 2010&#44; the European Society of Cardiology published guidelines for the management of patients with AF&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">17</span></a> These guidelines dedicate a specific paragraph to elderly populations&#46; Among other issues&#44; the guidelines state that AF is more common the older the patient and provide the clinical characteristics of this population&#46; Furthermore&#44; the guidelines emphasize that a strategy of heart rate control is preferable to rhythm control in the elderly population&#46; For the risk stratification of stroke and bleeding&#44; the guidelines propose the use of the CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc and HAS-BLED scales&#46; Unless contraindicated&#44; anticoagulation is recommended&#46; The benefit of antiplatelet treatment is highly limited in this population&#44; given that the risk of major bleeding episodes is very similar to that of anticoagulation&#44; while antiplatelet treatment is much less effective in terms of preventing stroke and cardiovascular events&#46; It has been suggested that an international normalized ratio &#40;INR&#41; range between 1&#46;8 and 2&#46;5 would be safer for the elderly population who undergo anticoagulation with vitamin K antagonists&#46; However&#44; the reality is that this range has not been endorsed by any clinical trial&#46; Cohort studies have suggested an increased risk of stroke with an INR range of 1&#46;5&#8211;2&#46;0&#59; therefore&#44; it is recommended that the INR not fall below 2&#46;0&#46; Only RE-LY study data have been published and the European Medicines Agency &#40;EMA&#44; <a href="http://www.ema.europa.eu/">http&#58;&#47;&#47;www&#46;ema&#46;europa&#46;eu&#47;</a>&#41; has not approved the use of vitamin K in patients with NVAF&#46; However these guidelines recommend the use of vitamin K antagonists&#44; although they make a number of general recommendations on the use of dabigatran &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">17</span></a></p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">The update to these guidelines was published in 2012&#46; These guidelines continue to recommend the use of the CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc and Has-BLED scales and emphasize the lack of benefit from acetylsalicylic acid&#46; They also comment on the results of 3 clinical trials with direct oral anticoagulants &#40;RE-LY&#44; ROCKET-AF and ARISTOTLE&#41; and the concern regarding its applicability to more elderly populations&#46; For patients aged 80 years and older&#44; the dabigatran dosage to be used is 110<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">18</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">The proposed guidelines by the American Heart Association and the American Stroke Association for the primary prevention of stroke emphasize the need to control arterial hypertension in the elderly &#40;mainly systolic blood pressure&#41;&#44; which&#44; along with appropriate antithrombotic treatment&#44; are essential for preventing the development of stroke in patients with AF&#46; In most elderly patients with stable ischemic heart disease and AF&#44; anticoagulant treatment is sufficient&#46; Moreover&#44; the detection of brain microhemorrhages in MRI could be useful when assessing the safety of antithrombotic treatment in an elderly patient &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">46</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">The 2012 Canadian AF guidelines indicate that advanced age &#40;&#62;75<span class="elsevierStyleHsp" style=""></span>years&#41; is considered a risk factor not only for stroke but also for hemorrhage&#44; particularly intracranial&#46; The use of the CHADS<span class="elsevierStyleInf">2</span>&#44; CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc and HAS-BLED scales is recommended&#46; With regard to direct oral anticoagulants&#44; dosage reductions are recommended for patients older than 75 years&#44; especially for those older than 80 and especially with dabigatran&#46; Moreover&#44; all patients with AF undergoing treatment with anticoagulants should undergo periodic monitoring of their renal function at least once a year &#40;more frequently in cases of renal failure&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">47</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">The recommendations proposed by the American College of Chest Physicians are not substantially different according to the age&#46; They do however specify that the risk of stroke increases with age&#44; as reflected in the CHADS<span class="elsevierStyleInf">2</span> risk stratification scale&#44; as well as the risk of bleeding &#40;older than 65 years on the HAS-BLED scale&#44; older than 75 years on the HEMORR<span class="elsevierStyleInf">2</span>HAGES scale&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">48</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">The guidelines of the European Heart Rhythm Association&#44; which specifically cover the use of direct oral anticoagulants in patients with NVAF&#44; insist on the need for renal function monitoring&#46; That is especially relevant in elderly patients &#40;older than 75 years&#41; or those who are taking dabigatran&#46; For patients with active cancer&#44; vitamin K antagonists or heparins are preferred over direct oral anticoagulants&#44; given the lack of experience with the latter in this context and possibility of interactions with chemotherapy drugs&#46; In the event that antiplatelet therapy is considered necessary in the first year after an acute ischemic episode&#44; the use of low doses of direct oral anticoagulants is considered safer&#44; especially for patients with HAS-BLED scores &#8805;3&#46; In this context&#44; vitamin K antagonists &#40;INR objective 2&#8211;2&#46;5&#41; might be preferable&#44; especially for very elderly populations and for those with renal failure &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">49</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">The guidelines of the Spanish Society of Neurology recommend anticoagulation&#44; except when contraindicated&#44; for patients with NVAF and a high risk of stroke &#40;patients older than 75 years&#41;&#46; For these patients&#44; both vitamin K antagonists and direct oral anticoagulants may be used&#46; In fact&#44; the guidelines specifically indicate that despite the hemorrhagic risk&#44; oral anticoagulants show a clear benefit in patients older than 85 years who have AF &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">50</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">The guidelines of the American College of Cardiology&#44; American Heart Association and Heart Rhythm Society have been recently published&#46; These guidelines have a specific section dedicated to the elderly population that indicates that the prevalence of AF increases with age and that the presence of other comorbidities is more common&#46; Clinicians usually opt for a heart rate control strategy&#44; more so than a rhythm control strategy&#44; especially considering the possibility of the adverse effects of antiarrhythmic agents in this population&#46; The use of the CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc scale is recommended&#44; as well as anticoagulation&#44; for patients aged 75 years or older&#44; either with vitamin K antagonists or direct oral anticoagulants&#44; except where contraindicated&#46; Patients&#8217; renal function should be measured before starting treatment with direct oral anticoagulants&#44; as well as subsequently during monitoring at least once a year &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">51</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Similarly&#44; guidelines proposed by a subcommittee of the American Academy of Neurology have been recently published&#46; These guidelines recognize the benefit of anticoagulation in elderly patients &#40;older than 75 years&#41;&#46; The main recommendation of these guidelines is that&#44; except where there is recent spontaneous bleeding or intracranial hemorrhage&#44; anticoagulation should be proposed for all elderly patients with NVAF&#44; including patients with mild dementia or occasional falls&#46; However&#44; the benefit of anticoagulation in patients with moderate to severe dementia or with frequent falls is uncertain &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">52</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">The recent NICE guidelines recommend&#44; on one hand&#44; a heart rate control strategy and&#44; on the other&#44; anticoagulation for those participants with NVAF and a CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc score &#8805;2&#46; Apixaban&#44; dabigatran&#44; rivaroxaban and vitamin K antagonists may be used&#46;<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">53</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">In summary&#44; the various clinical practice guidelines as a whole recognize that elderly patients with AF are complex patients with numerous comorbidities and who are frequently polymedicated&#46; All elderly patients with AF should &#40;unless contraindicated&#41; undergo permanent anticoagulant treatment&#44; although it is important to assess the risk of bleeding&#46; In terms of the type of oral anticoagulant to use in the elderly population&#44; both vitamin K antagonists and direct oral anticoagulants may be used in these patients&#46; If the latter are used&#44; it is important that renal function be monitored during follow-up&#44; especially when the patient has known renal failure or is taking dabigatran&#46; Unfortunately and despite the fact that the recommendations of the clinical practice guidelines appear clear&#44; a study performed with patients with NVAF in Spain found that 42&#37; of patients did not follow the recommendations of the European Society of Cardiology&#46;<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">54</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">How should our patient have been evaluated and treated&#63;</span><p id="par0165" class="elsevierStylePara elsevierViewall">Before the stroke&#44; this patient already presented a very high risk of thromboembolic complications &#40;CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc&#58; 4&#59; 2 points for age&#59; 1 point for hypertension and 1 point for diabetes&#41;&#46; The patient should have therefore undergone anticoagulation&#46; The two factors that had the greatest weight for not starting anticoagulation were the history of casual falls and the patient&#39;s age&#44; despite the high thromboembolic risk he had&#44; as subsequently happened&#46; The patient underwent anticoagulation after the stroke&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">In conclusion&#44; the management of NVAF in the elderly is complicated&#44; and&#44; due to the increased risk of thromboembolic complications and hemorrhage&#44; the decision to administer anticoagulation therapy should be individualized&#46; There are still unresolved questions and lack of evidence in this population&#46; Data from observational studies in our standard practice are needed and are important for the decision-making process&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Funding</span><p id="par0175" class="elsevierStylePara elsevierViewall">Editorial assistance was provided by Content Ed Net and sponsored by Bayer&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflicts of interest</span><p id="par0180" class="elsevierStylePara elsevierViewall">Dr&#46; Carmen Su&#225;rez has received has received honoraria for lectures and advising from BMS&#44; Pfizer&#44; Boheringher&#44; Bayer and Daichii Sankyo&#46; Dr&#46; Francesc Formiga has received honoraria for lectures and advising from BMS&#44; Pfizer&#44; Boheringher&#44; Bayer and Daichii Sankyo Dr&#46; A pose Reino declares having received honoraria for lectures and advising from BMS&#44; Pfizer&#44; Boheringher and Bayer&#46; The remaining authors declare having no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:13 [
        0 => array:3 [
          "identificador" => "xres468581"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec491222"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres468582"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec491221"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Case report"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "The clinical problem"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Epidemiological aspects"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Clinical profile of elderly patients with atrial fibrillation"
            ]
          ]
        ]
        6 => array:3 [
          "identificador" => "sec0025"
          "titulo" => "Strategies and evidence"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Anticoagulation with vitamin K antagonists for elderly patients"
            ]
            1 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Direct oral anticoagulants in elderly patients"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Controversy and issues to be resolved"
        ]
        8 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "What do the clinical practice guidelines say on this matter&#63;"
        ]
        9 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "How should our patient have been evaluated and treated&#63;"
        ]
        10 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Funding"
        ]
        11 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Conflicts of interest"
        ]
        12 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-10-10"
    "fechaAceptado" => "2014-11-30"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec491222"
          "palabras" => array:8 [
            0 => "Elderly"
            1 => "Nonvalvular atrial fibrillation"
            2 => "Guidelines"
            3 => "Vitamin K antagonists"
            4 => "Dabigatran"
            5 => "Rivaroxaban"
            6 => "Apixaban"
            7 => "Edoxaban"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec491221"
          "palabras" => array:8 [
            0 => "Anciano"
            1 => "Fibrilaci&#243;n auricular no valvular"
            2 => "Gu&#237;as"
            3 => "Antagonistas de la vitamina K"
            4 => "Dabigatran"
            5 => "Rivaroxaban"
            6 => "Apixaban"
            7 => "Edoxaban"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Atrial fibrillation &#40;AF&#41; in the elderly is a complex condition due to the high number of frequently associated comorbidities&#44; such as cardiovascular and kidney disease&#44; cognitive disorders&#44; falls and polypharmacy&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Except when contraindicated&#44; anticoagulation is necessary for preventing thromboembolic events in this population&#46; Both vitamin K antagonists and direct oral anticoagulants &#40;dabigatran&#44; rivaroxaban and apixaban&#41; are indicated in this context&#46; Renal function should be closely monitored for this age group when these drugs are used&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In recent years&#44; various clinical practice guidelines have been published on patients with AF&#46; The majority of these guidelines make specific recommendations on the clinical characteristics and treatment of elderly patients&#46; In this update&#44; we review the specific comments on the recommendations concerning antithrombotic treatment in elderly patients with nonvalvular AF&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La fibrilaci&#243;n auricular &#40;FA&#41; en el anciano es una entidad compleja debido al elevado n&#250;mero de comorbilidades frecuentemente asociadas&#44; como las enfermedades cardiovasculares y la enfermedad renal&#44; los trastornos cognitivos&#44; las ca&#237;das o la polimedicaci&#243;n&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Excepto cuanto est&#233; contraindicada&#44; la anticoagulaci&#243;n es necesaria para la prevenci&#243;n de los eventos tromboemb&#243;licos en esta poblaci&#243;n&#46; Tanto los antagonistas de la vitamina K como los anticoagulantes orales de acci&#243;n directa &#40;dabigatran&#44; rivaroxaban y apixaban&#41; est&#225;n indicados en este contexto&#46; En este grupo de edad la funci&#243;n renal debe ser estrechamente vigilada cuando se utilizan estos &#250;ltimos&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">En los &#250;ltimos a&#241;os se han publicado diferentes gu&#237;as de pr&#225;ctica cl&#237;nica sobre el paciente con FA&#46; La mayor&#237;a de estas gu&#237;as realizan recomendaciones espec&#237;ficas sobre las caracter&#237;sticas cl&#237;nicas y el tratamiento en los pacientes ancianos&#46; En esta actualizaci&#243;n se revisan los comentarios espec&#237;ficos sobre las recomendaciones referentes al tratamiento antitromb&#243;tico en los pacientes ancianos con FA no valvular&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Su&#225;rez Fern&#225;ndez C&#44; Camafort M&#44; Cepeda Rodrigo JM&#44; D&#237;ez-Manglano J&#44; Formiga F&#44; Pose Reino A&#44; et al&#46; Tratamiento antitromb&#243;tico en el paciente anciano con fibrilaci&#243;n auricular&#46; Rev Clin Esp&#46; 2015&#59;215&#58;171&#8211;181&#46;</p>"
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviation</span>&#58; AF&#44; atrial fibrillation&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Adapted from&#58; Lubitz et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">1</span></a> Go et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">2</span></a> Heeringa et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">3</span></a> Barrios et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">4</span></a> G&#243;mez-Doblas et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">5</span></a> Baena-D&#237;ez et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">6</span></a> L&#243;pez Soto et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">7</span></a> Rodr&#237;guez-Ma&#241;ero et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">8</span></a> Barrios et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">9</span></a> Freedman et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">10</span></a> M&#233;rida-Rodrigo et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">11</span></a> Hanon et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">12</span></a> R&#248;nning et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">16</span></a> Camm et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">17</span></a> Camm et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">18</span></a> Pisters et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">19</span></a> Lip et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">20</span></a> Mant et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">26</span></a> Lip and Lane&#44;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">27</span></a> Siu and Tse&#44;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">28</span></a> Formiga et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">30</span></a> Gage et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">31</span></a> Gao et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">32</span></a> Darnell et al&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">33</span></a> and Fuenzalida et al&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">34</span></a></p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">The prevalence and incidence of AF increase with age&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Stroke associated with AF&#44; when compared with stroke unrelated to AF&#44; has increased mortality and morbidity and more sequela&#44; especially in the elderly&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Elderly patients with AF have a higher number of hospitalizations&#44; increased mortality and generate a greater degree of dependence when compared with younger patients&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Elderly patients have a considerable number of comorbidities&#44; which frequently results in polymedication&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">They also have other physical and mental disorders&#44; especially cognitive and mood disorders&#44; risk of falls&#44; malnutrition and social dependence&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">They are frequently underdiagnosed&#44; given that AF often progresses in the elderly asymptomatically or with few symptoms&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Advanced age is an independent predictor of stroke and mortality after stroke&#44; as well as a risk of bleeding&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Except where contraindicated&#44; elderly patients with AF should undergo anticoagulation&#46; However&#44; many are not due to the fear of bleeding&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab725463.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Peculiarities of atrial fibrillation in the elderly patient&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; NVAF&#44; nonvalvular atrial fibrillation&#59; CrCl&#44; creatinine clearance&#59; ITT&#44; intention to treat&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Adapted from Eikelboom et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">37</span></a> Halperin et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">39</span></a> Halvorsen et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">40</span></a> and Giugliano et al&#46;<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">42</span></a></p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Population&#47;comparator groups&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Results&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">RE-LY&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#44;113 patients &#40;mean age&#44; 71&#46;5 years&#59; 40&#46;1&#37; &#8805;75<span class="elsevierStyleHsp" style=""></span>years&#59; mean CHADS<span class="elsevierStyleInf">2</span> score&#44; 2&#46;1&#41; with NVAF were randomized to dabigatran 110<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h&#44; dabigatran 150<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h or warfarin&#46; Mean follow-up&#44; 2&#46;0 years&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">When compared with warfarin&#44; both dabigatran dosages &#40;110<span class="elsevierStyleHsp" style=""></span>mg and 150<span class="elsevierStyleHsp" style=""></span>mg twice daily&#41; presented a lower risk of intracranial and extracranial bleeding in participants younger than 75 years&#46; For participants 75 years or older&#44; intracranial bleeding was less frequent but extracranial was the same or more frequent&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">ROCKET-AF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;264 patients with NVAF &#40;mean age&#44; 73 years&#59; 44&#37; &#8805;75 years&#59; mean CHADS<span class="elsevierStyleInf">2</span> score&#44; 3&#46;4&#41; were randomized to rivaroxaban &#40;20<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#59; 15<span class="elsevierStyleHsp" style=""></span>mg if CrCl &#60;50<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#41; in comparison with warfarin&#46; Mean follow-up of 707 days in the ITT analysis&#59; 590 days in the per-protocol analysis&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The elderly patients had a greater risk of stroke and major bleeding episodes when compared with the younger patients&#46;The efficacy &#40;risk of stroke and systemic embolism&#41; and safety &#40;risk of major bleeding episodes&#41; of rivaroxaban when compared with warfarin were consistent with the overall results of the study&#44; regardless of age&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">ARISTOTLE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#44;201 patients &#40;mean age&#44; 70 years&#59; 31&#37; &#8805;75 years&#59; 13&#37; &#8805;80 years&#59; mean CHADS<span class="elsevierStyleInf">2</span> score&#44; 2&#46;1&#41; with NVAF were randomized to apixaban 5<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h &#40;or 2&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h in case &#8805;2 of the following criteria were met&#58; age &#8805;80 years&#44; weight &#8804;60<span class="elsevierStyleHsp" style=""></span>kg&#44; or creatinine level &#8805;133<span class="elsevierStyleHsp" style=""></span>&#956;mol&#47;L&#41; or warfarin&#46; Mean follow-up&#44; 1&#46;8 years&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Apixaban was more effective in reducing the risk of stroke and mortality&#44; with fewer major bleeding episodes&#44; total bleeding episodes and intracranial bleeding episodes&#44; regardless of age&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">ENGAGE AF-TIMI 48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#44;105 patients &#40;mean age&#44; 72 years&#59; 40&#46;1&#37; &#8805;75 years&#59; mean CHADS<span class="elsevierStyleInf">2</span> score&#44; 2&#46;8&#41; with NVAF were randomized to edoxaban 30<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#44; edoxaban 60<span class="elsevierStyleHsp" style=""></span>mg&#47;day or warfarin&#46; Mean follow-up&#44; 2&#46;8 years&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Both edoxaban dosages &#40;30 and 60<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41; were noninferior to warfarin with respect to preventing stroke and systemic embolism but had fewer major bleeding episodes&#44; regardless of age&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab725464.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Results of the RE-LY&#44; ROCKET-AF&#44; ARISTOTLE and ENGAGE AF-TIMI 48 studies by age&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; CrCl&#44; creatinine clearance&#59; NVAF&#44; nonvalvular atrial fibrillation&#46;</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Adapted from&#58; European Medicines Agency &#40;EMA&#41;&#44; Pradaxa<span class="elsevierStyleSup">&#174;</span><a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">43</span></a>&#59; European Medicines Agency &#40;EMA&#41;&#44; Xarelto<span class="elsevierStyleSup">&#174;</span><a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">44</span></a>&#59; and European Medicines Agency &#40;EMA&#41;&#44; Eliquis<span class="elsevierStyleSup">&#174;</span><a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">45</span></a>&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Drug&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dosage adjustment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Dabigatran&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; <span class="elsevierStyleItalic">Based on age</span>&#58;<span class="elsevierStyleHsp" style=""></span>&#8226; 75 years&#58; 150<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h<span class="elsevierStyleHsp" style=""></span>&#8226; 75&#8211;80 years&#58; 150 or 110<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h&#44; depending on thrombotic&#47;hemorrhagic risk<span class="elsevierStyleHsp" style=""></span>&#8226; &#8805;80 years&#58; 110<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h&#8226; <span class="elsevierStyleItalic">Based on renal function&#58;</span>If CrCl &#8805;50<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#58; dosage adjustment not necessary&#46;<span class="elsevierStyleHsp" style=""></span>&#8226; If CrCl is 30&#8211;50<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#58; assess 150<span class="elsevierStyleHsp" style=""></span>mg or 110<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h&#44; depending on thrombotic&#47;hemorrhagic risk&#46;<span class="elsevierStyleHsp" style=""></span>&#8226; If CrCl &#60;30<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#58; contraindicated&#8226; <span class="elsevierStyleItalic">Concomitant use of verapamil&#58; 110</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mg&#47;12</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">h</span>&#8226; <span class="elsevierStyleItalic">Based on weight&#58; A dosage adjustment is not necessary&#44; although close follow-up is recommended for patients weighing &#60;50</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">kg</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Rivaroxaban&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; <span class="elsevierStyleItalic">Based on age&#58; No dosage adjustment required</span>&#8226; <span class="elsevierStyleItalic">Based on renal function&#58;</span><span class="elsevierStyleHsp" style=""></span>&#8226; If CrCl &#8805;50<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#58; recommended dosage is 20<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#46;<span class="elsevierStyleHsp" style=""></span>&#8226; If CrCl is 15&#8211;49<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#58; recommended dosage is 15<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#46;<span class="elsevierStyleHsp" style=""></span>&#8226; If CrCl &#60;15<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#58; not recommended&#46;&#8226; <span class="elsevierStyleItalic">Based on weight&#58; No dosage adjustment required</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Apixaban&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; <span class="elsevierStyleItalic">In general&#44; the recommended dosage is 5</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mg&#47;12</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">h&#46; The dosage should be reduced to 2&#46;5</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mg&#47;12</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">h for NVAF and &#8805;2 of the following criteria&#58; &#8805;80 years&#44; &#8804;60</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">kg or serum creatinine level &#8805;1&#46;5</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mg&#47;dL&#46;</span>&#8226; <span class="elsevierStyleItalic">Based on age&#58; No dosage adjustment required&#44; except for age &#8805;80 years&#44; weight &#8804;60</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">kg or creatinine level &#8805;1&#46;5</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mg&#47;dL&#46;</span>&#8226; <span class="elsevierStyleItalic">Based on renal function&#58;</span><span class="elsevierStyleHsp" style=""></span>&#8226; Dosage adjustments are not required for patients with mild to moderate renal failure&#46;<span class="elsevierStyleHsp" style=""></span>&#8226; If creatinine level is &#8805;1&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#58; recommended dosage is 5<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h&#44; except for patients &#8805;80 years or &#8804;60<span class="elsevierStyleHsp" style=""></span>kg for whom the dosage should be reduced to 2&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h&#46;<span class="elsevierStyleHsp" style=""></span>&#8226; If CrCl is 15&#8211;29<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#58; recommended dosage is 2&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h&#46;<span class="elsevierStyleHsp" style=""></span>&#8226; If CrCl is &#60;15<span class="elsevierStyleHsp" style=""></span>mL&#47;min or on dialysis&#58; not recommended&#46;&#8226; <span class="elsevierStyleItalic">Based on weight&#58; No dosage adjustment required&#44; except for age &#8805;80 years&#44; weight &#8804;60</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">kg or creatinine level &#8805;1&#46;5</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mg&#47;dL&#46;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab725462.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Dosage adjustment of dabigatran&#44; rivaroxaban and apixaban for patients with nonvalvular atrial fibrillation&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; ESC&#44; European Society of Cardiology&#59; NICE&#44; National Institute for Health and Care Excellence&#59; SEN&#44; Spanish Society of Neurology&#46;</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Adapted from Camm et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">17</span></a> Camm et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">18</span></a> EMA Pradaxa<span class="elsevierStyleSup">&#174;</span>&#44;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">43</span></a> EMA Xarelto<span class="elsevierStyleSup">&#174;</span>&#44;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">44</span></a> EMA Eliquis<span class="elsevierStyleSup">&#174;</span>&#44;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">45</span></a> Goldstein et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">46</span></a> Skanes et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">47</span></a> You et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">48</span></a> Heidbuchel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">49</span></a> and Fuentes et al&#46;<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">50</span></a></p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Guidelines &#40;year of publication&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Recommendations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">ESC &#40;2010&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Specific section dedicated to the elderly population&#46;Compared with younger patients&#44; the elderly&#58;Are frailer and have more comorbidities&#46;Permanent AF is more common than paroxysmal&#47;persistent AF&#46;Atypical symptoms are more common&#46;They have a greater likelihood of presenting adverse effects from the drugs&#46;They are frequently underdiagnosed&#46;In general&#44; a heart rate control strategy is preferred over a rhythm control strategy&#46;Given that patients older than 75 years with AF have a &#62;4&#37; annual risk of presenting thromboembolic complications&#44; anticoagulation is indicated unless the risk of bleeding is very high &#40;the benefit of antiplatelet therapy is very limited in this population&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">American Heart Association&#47;American Stroke Association &#40;2011&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">To prevent stroke in the elderly&#44; it is essential to control blood pressure &#40;mainly systolic&#41; and have appropriate antithrombotic treatment&#46;The effects of combining antiplatelet with anticoagulant treatment in this population have not been clearly established&#46;In most elderly patients with stable ischemic heart disease and AF&#44; anticoagulant treatment is sufficient&#46;The detection of brain microhemorrhages in MRI could be useful when assessing the safety of antithrombotic treatment in an elderly patient&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">ESC &#40;2012&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The guidelines continue to recommend the use of the CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc and HAS-BLED scales for the risk stratification of stroke and bleeding&#44; respectively&#46;The guidelines emphasize the scarce benefit of aspirin for these patients&#44; with a high risk of bleeding&#44; and that its use should be limited to those patients who reject any type of anticoagulation&#46;There is concern on how to adapt the results of clinical trials with direct oral anticoagulants to the more elderly population&#44; who have numerous comorbidities and are frequently polymedicated&#44; as well as the fact that individuals with severe renal failure were excluded from these studies&#46; This is particularly important with dabigatran&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Canadian Guidelines &#40;2012&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The guidelines recommend the use of the CHADS<span class="elsevierStyleInf">2</span> and CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc scales for the risk stratification of stroke and the HAS-BLED scale for assessing the risk of bleeding&#46;With regard to direct oral anticoagulants&#44; dosage reductions are recommended for patients older than 75 years&#44; especially for those older than 80 and especially with dabigatran&#46;All patients with AF undergoing treatment with anticoagulants should undergo periodic monitoring of their renal function at least once a year&#46; Patients with a glomerular filtration rate of 30&#8211;50<span class="elsevierStyleHsp" style=""></span>mL&#47;min need a closer monitoring of their renal function and might require anticoagulant dosage reductions in certain conditions&#46; This is especially important for patients older than 75 years&#44; in whom the risk of bleeding increases significantly&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">American College of Chest Physicians &#40;2012&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">There are no substantial differences by age&#46;The guidelines specify that the risk of stroke and bleeding increases with age&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">European Heart Rhythm Association &#40;2013&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Specific guidelines on direct oral anticoagulants for patients with NVAF&#46;The guidelines insist on the need to monitor renal function &#40;annually&#44; every 6 months and every 3 months for creatinine clearance levels &#8805;60&#44; 30&#8211;60 and &#60;30<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#44; respectively&#41;&#46; This is especially relevant in elderly patients &#40;older than 75 years&#41; or those who are taking dabigatran&#46;For patients with concomitant active cancer who need anticoagulation&#44; vitamin K antagonists or heparins are preferred over direct oral anticoagulants&#46;In the event that antiplatelet therapy is considered necessary in the first year after an acute ischemic episode&#44; the use of low doses of direct oral anticoagulants is considered safer&#44; especially for patients with HAS-BLED scores &#8805;3&#46; In this context&#44; vitamin K antagonists &#40;INR objective 2&#8211;2&#46;5&#41; might be preferable&#44; especially for very elderly populations and for those with renal failure&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">SEN &#40;2014&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The guidelines recommend anticoagulation for patients with NVAF and a high risk of stroke &#40;CHADS<span class="elsevierStyleInf">2</span> score &#8805;2 or CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc score &#8805;1&#41;&#46; Therefore&#44; all patients older than 75 years should undergo anticoagulation&#44; except where contraindicated&#46;Vitamin K antagonists and direct oral anticoagulants may be used&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">American College of Cardiology&#47;American Heart Association&#47;Heart Rhythm Society &#40;2014&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Specific section dedicated to the elderly population&#46;Elderly patients have a greater possibility of presenting other comorbidities&#44; which can influence the approach&#46;Given that AF symptoms in these patients are usually scarce&#44; a heart rate control strategy is usually selected&#46;The guidelines recommend the use of the CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc scale for the risk stratification of stroke in patients with NVAF&#44; recommending anticoagulation &#40;either with vitamin K antagonists or direct oral anticoagulants&#41; for patients with a CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc score &#8805;2&#46;Patients&#8217; renal function should be measured before starting treatment with direct oral anticoagulants&#44; as well as subsequently at least once a year&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">American Academy of Neurology &#40;2014&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">These guidelines recognize the benefit of anticoagulation in elderly patients &#40;older than 75 years&#41;&#46; However&#44; many physicians do not use them because they believe that there is a very high risk of bleeding&#46;Except where there is recent spontaneous bleeding or intracranial hemorrhage&#44; anticoagulation should be proposed for all elderly patients with NVAF&#44; including patients with mild dementia or occasional falls&#46;The benefit of anticoagulation in patients with moderate to severe dementia or with frequent falls is uncertain&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">NICE &#40;2014&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">In patients aged 75 years or older&#44; the prevalence of AF is high &#40;almost 15&#37;&#41;&#46;A heart rate control strategy is recommended over a rhythm control strategy&#46;The use of anticoagulation is recommended for patients with a CHA2DS2-VASc score &#8805;2&#46;For patients aged 75 years or older&#44; anticoagulation &#40;with apixaban&#44; dabigatran&#44; rivaroxaban or the vitamin K antagonists&#41; should be started&#44; except when the risk of bleeding is very high&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab725461.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Specific recommendations from the clinical practice guidelines on elderly patients with atrial fibrillation&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:54 [
            0 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Stroke prevention in atrial fibrillation in older adults&#58; existing knowledge gaps and areas for innovation&#58; a summary of an American Federation for Aging research seminar"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;A&#46; Lubitz"
                            1 => "K&#46;A&#46; Bauer"
                            2 => "E&#46;J&#46; Benjamin"
                            3 => "R&#46;W&#46; Besdine"
                            4 => "D&#46;E&#46; Forman"
                            5 => "M&#46;E&#46; Gurol"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jgs.12456"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Geriatr Soc"
                        "fecha" => "2013"
                        "volumen" => "61"
                        "paginaInicial" => "1798"
                        "paginaFinal" => "1803"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24083473"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of diagnosed atrial fibrillation in adults&#58; national implications for rhythm management and stroke prevention&#58; the AnTicoagulation and Risk Factors in Atrial Fibrillation &#40;ATRIA&#41; Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;S&#46; Go"
                            1 => "E&#46;M&#46; Hylek"
                            2 => "K&#46;A&#46; Phillips"
                            3 => "Y&#46; Chang"
                            4 => "L&#46;E&#46; Henault"
                            5 => "J&#46;V&#46; Selby"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Med Assoc"
                        "fecha" => "2001"
                        "volumen" => "285"
                        "paginaInicial" => "2370"
                        "paginaFinal" => "2375"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence&#44; incidence and lifetime risk of atrial fibrillation&#58; the Rotterdam study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Heeringa"
                            1 => "D&#46;A&#46;M&#46; Van der Kuip"
                            2 => "A&#46; Hofman"
                            3 => "J&#46;A&#46; Kors"
                            4 => "G&#46; Van Herpen"
                            5 => "B&#46; Stricker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehi825"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2006"
                        "volumen" => "27"
                        "paginaInicial" => "949"
                        "paginaFinal" => "953"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16527828"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pacientes con fibrilaci&#243;n auricular asistidos en consultas de atenci&#243;n primaria&#46; Estudio Val-FAAP"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "V&#46; Barrios"
                            1 => "A&#46; Calder&#243;n"
                            2 => "C&#46; Escobar"
                            3 => "M&#46; De la Figuera"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.recesp.2011.08.008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Cardiol"
                        "fecha" => "2012"
                        "volumen" => "65"
                        "paginaInicial" => "47"
                        "paginaFinal" => "53"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22054913"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalencia de fibrilaci&#243;n auricular en Espa&#241;a&#46; Resultados del estudio OFRECE"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;J&#46; G&#243;mez-Doblas"
                            1 => "J&#46; Mu&#241;iz"
                            2 => "J&#46;J&#46; Martin"
                            3 => "G&#46; Rodr&#237;guez-Roca"
                            4 => "J&#46;M&#46; Lobos"
                            5 => "P&#46; Awamleh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rec.2013.07.014"
                      "Revista" => array:7 [
                        "tituloSerie" => "Rev Esp Cardiol"
                        "fecha" => "2014"
                        "volumen" => "67"
                        "paginaInicial" => "259"
                        "paginaFinal" => "269"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24774588"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1058274613005533"
                          "estado" => "S300"
                          "issn" => "10582746"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalencia de fibrilaci&#243;n auricular y factores asociados en Espa&#241;a&#44; an&#225;lisis de seis estudios de base poblacional&#46; Estudio DARIOS"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "en representaci&#243;n del estudio DARIOS"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;M&#46; Baena-D&#237;ez"
                            1 => "M&#46; Grau"
                            2 => "R&#46; For&#233;s"
                            3 => "D&#46; Fern&#225;ndez-Berg&#233;s"
                            4 => "R&#46; Elosua"
                            5 => "M&#46; Sorribes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rce.2014.06.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Clin Esp"
                        "fecha" => "2014"
                        "volumen" => "214"
                        "paginaInicial" => "505"
                        "paginaFinal" => "512"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25087090"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalencia de la fibrilaci&#243;n auricular y factores relacionados en pacientes ancianos hospitalizados&#58; estudio ESFINGE"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "en representaci&#243;n de los investigadores del estudio ESFINGE"
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; L&#243;pez Soto"
                            1 => "F&#46; Formiga"
                            2 => "X&#46; Bosch"
                            3 => "J&#46; Garc&#237;a Alegr&#237;a"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;"
                        "fecha" => "2012"
                        "volumen" => "138"
                        "paginaInicial" => "231"
                        "paginaFinal" => "237"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Trends in clinical profile and medical treatments of atrial fibrillation patients over the last 10 years"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Rodr&#237;guez-Ma&#241;ero"
                            1 => "V&#46; Bertomeu-Gonz&#225;lez"
                            2 => "A&#46; Cordero"
                            3 => "J&#46; Moreno-Arribas"
                            4 => "P&#46; Maz&#243;n"
                            5 => "L&#46; F&#225;cila"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.repc.2012.06.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Port Cardiol"
                        "fecha" => "2013"
                        "volumen" => "32"
                        "paginaInicial" => "103"
                        "paginaFinal" => "109"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23337429"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Atrial fibrillation and coronary heart disease&#58; fatal attraction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "V&#46; Barrios"
                            1 => "C&#46; Escobar"
                            2 => "R&#46; Echarri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Atr Fibrillation"
                        "fecha" => "2009"
                        "volumen" => "1"
                        "paginaInicial" => "262"
                        "paginaFinal" => "269"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Atrial fibrillation and stroke prevention in aging patients&#58; what&#39;s good can be even better"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;E&#46; Freedman"
                            1 => "B&#46;J&#46; Gersh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.114.010873"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2014"
                        "volumen" => "130"
                        "paginaInicial" => "129"
                        "paginaFinal" => "131"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24895453"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Supervivencia a largo plazo del ictus isqu&#233;mico"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; M&#233;rida-Rodrigo"
                            1 => "F&#46; Poveda-G&#243;mez"
                            2 => "M&#46; Camafort-Babkowski"
                            3 => "F&#46; Rivas-Ruiz"
                            4 => "M&#46;D&#46; Mart&#237;n-Escalante"
                            5 => "R&#46; Quir&#243;s-L&#243;pez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rce.2011.12.019"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Clin Esp"
                        "fecha" => "2012"
                        "volumen" => "212"
                        "paginaInicial" => "223"
                        "paginaFinal" => "228"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22425144"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "French society of geriatrics and gerontology and the French society of cardiology&#46; Expert consensus of the French society of geriatrics and gerontology and the French society of cardiology on the management of atrial fibrillation in elderly people"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "O&#46; Hanon"
                            1 => "P&#46; Assayag"
                            2 => "J&#46; Belmin"
                            3 => "J&#46;P&#46; Collet"
                            4 => "J&#46;P&#46; Emeriau"
                            5 => "L&#46; Fauchier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1684/pnv.2013.0407"
                      "Revista" => array:6 [
                        "tituloSerie" => "Geriatr Psychol Neuropsychiatr Vieil"
                        "fecha" => "2013"
                        "volumen" => "11"
                        "paginaInicial" => "117"
                        "paginaFinal" => "143"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23803629"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The impact of age on the epidemiology of atrial fibrillation hospitalizations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Naderi"
                            1 => "Y&#46; Wang"
                            2 => "A&#46;L&#46; Miller"
                            3 => "F&#46; Rodriguez"
                            4 => "M&#46;K&#46; Chung"
                            5 => "M&#46;J&#46; Radford"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amjmed.2014.07.026"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Med"
                        "fecha" => "2014"
                        "volumen" => "127"
                        "paginaInicial" => "e1"
                        "paginaFinal" => "e7"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25195188"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Caracter&#237;sticas y costes de los pacientes ingresados por arritmias cardiacas en Espa&#241;a"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Montes-Santiago"
                            1 => "V&#46; Rodil"
                            2 => "F&#46; Formiga"
                            3 => "J&#46;M&#46; Cepeda"
                            4 => "A&#46; Urrutia"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rce.2013.02.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Clin Esp"
                        "fecha" => "2013"
                        "volumen" => "213"
                        "paginaInicial" => "235"
                        "paginaFinal" => "239"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23561445"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Atrial fibrillation and incidence of dementia&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46;S&#46; Kwok"
                            1 => "Y&#46;K&#46; Loke"
                            2 => "R&#46; Hale"
                            3 => "J&#46;F&#46; Potter"
                            4 => "P&#46;K&#46; Myint"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1212/WNL.0b013e31820f2e38"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurology"
                        "fecha" => "2011"
                        "volumen" => "76"
                        "paginaInicial" => "914"
                        "paginaFinal" => "922"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21383328"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictors of mortality following acute stroke&#58; a cohort study with 12 years of follow-up"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "O&#46;M&#46; R&#248;nning"
                            1 => "K&#46; Stavem"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jstrokecerebrovasdis.2010.09.012"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Stroke Cerebrovasc Dis"
                        "fecha" => "2012"
                        "volumen" => "21"
                        "paginaInicial" => "369"
                        "paginaFinal" => "372"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21075646"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines for the management of atrial fibrillation&#58; the Task Force for the Management of atrial fibrillation of the European Society of Cardiology &#40;ESC&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;J&#46; Camm"
                            1 => "P&#46; Kirchhof"
                            2 => "G&#46;Y&#46; Lip"
                            3 => "U&#46; Schotten"
                            4 => "I&#46; Savelieva"
                            5 => "S&#46; Ernst"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehq278"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2010"
                        "volumen" => "31"
                        "paginaInicial" => "2369"
                        "paginaFinal" => "2429"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20802247"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2012 focused update of the ESC Guidelines for the management of atrial fibrillation&#58; an update of the 2010 ESC Guidelines for the management of atrial fibrillation&#46; Developed with the special contribution of the European Heart Rhythm Association"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;J&#46; Camm"
                            1 => "G&#46;Y&#46; Lip"
                            2 => "R&#46; de Caterina"
                            3 => "I&#46; Savelieva"
                            4 => "D&#46; Atar"
                            5 => "S&#46;H&#46; Hohnloser"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehs253"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2012"
                        "volumen" => "33"
                        "paginaInicial" => "2719"
                        "paginaFinal" => "2747"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22922413"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A novel user-friendly score &#40;HAS-BLED&#41; to assess 1-year risk of major bleeding in patients with atrial fibrillation&#58; the Euro Heart Survey"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46; Pisters"
                            1 => "D&#46;A&#46; Lane"
                            2 => "R&#46; Nieuwlaat"
                            3 => "C&#46;B&#46; de Vos"
                            4 => "H&#46;J&#46; Crijns"
                            5 => "G&#46;Y&#46; Lip"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.10-0134"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2010"
                        "volumen" => "138"
                        "paginaInicial" => "1093"
                        "paginaFinal" => "1100"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20299623"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach&#58; the Euro Heart Survey on atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46;Y&#46; Lip"
                            1 => "R&#46; Nieuwlaat"
                            2 => "R&#46; Pisters"
                            3 => "D&#46;A&#46; Lane"
                            4 => "H&#46;J&#46; Crijns"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.09-1584"
                      "Revista" => array:7 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2010"
                        "volumen" => "137"
                        "paginaInicial" => "263"
                        "paginaFinal" => "272"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19762550"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1058274613003856"
                          "estado" => "S300"
                          "issn" => "10582746"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0375"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Atrial fibrillation in the elderly"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46; Nantsupawat"
                            1 => "K&#46; Nugent"
                            2 => "A&#46; Phrommintikul"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s40266-013-0094-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Drugs Aging"
                        "fecha" => "2013"
                        "volumen" => "30"
                        "paginaInicial" => "593"
                        "paginaFinal" => "601"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23709402"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0380"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Warfarin versus aspirin for prevention of cognitive decline in atrial fibrillation&#58; randomized controlled trial &#40;Birmingham atrial fibrillation treatment of the aged study&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Mavaddat"
                            1 => "A&#46; Roalfe"
                            2 => "K&#46; Fletcher"
                            3 => "G&#46;Y&#46; Lip"
                            4 => "F&#46;D&#46; Hobbs"
                            5 => "D&#46; Fitzmaurice"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/STROKEAHA.113.004009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Stroke"
                        "fecha" => "2014"
                        "volumen" => "45"
                        "paginaInicial" => "1381"
                        "paginaFinal" => "1386"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24692475"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0385"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Decisional algorithm to prescribe vitamin K antagonist in geriatric patients with atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;S&#46; Sibai"
                            1 => "F&#46; Bellarbre"
                            2 => "N&#46; Ghazali"
                            3 => "M&#46;L&#46; Bureau"
                            4 => "M&#46; Priner"
                            5 => "P&#46; Ingrand"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1684/pnv.2014.0458"
                      "Revista" => array:6 [
                        "tituloSerie" => "Geriatr Psychol Neuropsychiatr Vieil"
                        "fecha" => "2014"
                        "volumen" => "12"
                        "paginaInicial" => "20"
                        "paginaFinal" => "24"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24647235"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0390"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Meta-analysis&#58; antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46;G&#46; Hart"
                            1 => "L&#46;A&#46; Pearce"
                            2 => "M&#46;I&#46; Aguilar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "2007"
                        "volumen" => "146"
                        "paginaInicial" => "857"
                        "paginaFinal" => "867"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17577005"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0395"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Oral anticoagulants versus antiplatelet therapy for preventing stroke in patients with non-valvular atrial fibrillation and no history of stroke or transient ischemic attacks"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;I&#46; Aguilar"
                            1 => "R&#46; Hart"
                            2 => "L&#46;A&#46; Pearce"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/14651858.CD009601.pub2"
                      "Revista" => array:4 [
                        "tituloSerie" => "Cochrane Database Syst Rev"
                        "fecha" => "2007"
                        "volumen" => "3"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23543580"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0400"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation &#40;the Birmingham Atrial Fibrillation Treatment of the Aged Study&#44; BAFTA&#41;&#58; a randomised controlled trial"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Midland Research Practices Network &#40;MidReC&#41;"
                          "etal" => true
                          "autores" => array:7 [
                            0 => "J&#46; Mant"
                            1 => "F&#46;D&#46; Hobbs"
                            2 => "K&#46; Fletcher"
                            3 => "A&#46; Roalfe"
                            4 => "D&#46; Fitzmaurice"
                            5 => "G&#46;Y&#46; Lip"
                            6 => "BAFTA investigators"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(07)61233-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2007"
                        "volumen" => "370"
                        "paginaInicial" => "493"
                        "paginaFinal" => "503"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17693178"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0405"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Stroke prevention with oral anticoagulation therapy in patients with atrial fibrillation &#8211; focus on the elderly"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46;Y&#46; Lip"
                            1 => "D&#46;A&#46; Lane"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circ J"
                        "fecha" => "2013"
                        "volumen" => "77"
                        "paginaInicial" => "1380"
                        "paginaFinal" => "1388"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23657131"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0410"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Net clinical benefit of warfarin therapy in elderly Chinese patients with atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46;W&#46; Siu"
                            1 => "H&#46;F&#46; Tse"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCEP.113.000858"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circ Arrhythm Electrophysiol"
                        "fecha" => "2014"
                        "volumen" => "7"
                        "paginaInicial" => "300"
                        "paginaFinal" => "306"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24610776"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0415"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Should patient characteristics influence target anticoagulation intensity for stroke prevention in nonvalvular atrial fibrillation&#58; the ATRIA study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;E&#46; Singer"
                            1 => "Y&#46; Chang"
                            2 => "M&#46;C&#46; Fang"
                            3 => "L&#46;H&#46; Borowsky"
                            4 => "N&#46;K&#46; Pomernacki"
                            5 => "N&#46; Udaltsova"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCOUTCOMES.108.830232"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circ Cardiovasc Qual Outcomes"
                        "fecha" => "2009"
                        "volumen" => "2"
                        "paginaInicial" => "297"
                        "paginaFinal" => "304"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20031854"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0420"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bajo porcentaje de anticoagulaci&#243;n oral en nonagenarios con fibrilaci&#243;n auricular"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "F&#46; Formiga"
                            1 => "A&#46; Ferrer"
                            2 => "E&#46; Henr&#237;quez"
                            3 => "R&#46; Pujol"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Clin Esp"
                        "fecha" => "2006"
                        "volumen" => "206"
                        "paginaInicial" => "410"
                        "paginaFinal" => "411"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16863634"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0425"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adverse outcomes and predictors of underuse of antithrombotic therapy in medicare beneficiaries with chronic atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46;F&#46; Gage"
                            1 => "M&#46; Boechler"
                            2 => "A&#46;L&#46; Doggette"
                            3 => "G&#46; Fortune"
                            4 => "G&#46;C&#46; Flaker"
                            5 => "M&#46;W&#46; Rich"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Stroke"
                        "fecha" => "2000"
                        "volumen" => "31"
                        "paginaInicial" => "822"
                        "paginaFinal" => "827"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10753982"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0430"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Analysis of antithrombotic therapy in elderly patients with atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "W&#46;Q&#46; Gao"
                            1 => "Y&#46;T&#46; Guo"
                            2 => "J&#46;L&#46; Ma"
                            3 => "P&#46; Zhu"
                            4 => "Y&#46;T&#46; Wang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4238/2014.January.29.4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Genet Mol Res"
                        "fecha" => "2014"
                        "volumen" => "13"
                        "paginaInicial" => "736"
                        "paginaFinal" => "743"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24615038"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0435"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bleeding risk factors affecting warfarin therapy in the elderly with atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46;W&#46; Darnell"
                            1 => "S&#46;C&#46; Davis"
                            2 => "J&#46;J&#46; Whitcomb"
                            3 => "J&#46;A&#46; Manfredi"
                            4 => "B&#46;T&#46; McLaurin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/DCC.0000000000000022"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dimens Crit Care Nurs"
                        "fecha" => "2014"
                        "volumen" => "33"
                        "paginaInicial" => "57"
                        "paginaFinal" => "63"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24496251"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0440"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evoluci&#243;n temporal del tratamiento de los pacientes con fibrilaci&#243;n auricular en un &#225;rea sanitaria urbana"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "en nombre de la Unidad de Fibrilaci&#243;n Auricular del Hospital Cl&#237;nic de Barcelona &#40;UFA&#41;"
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46; Fuenzalida"
                            1 => "B&#46; Coll-Vinent"
                            2 => "M&#46; Navarro"
                            3 => "A&#46; Cervera"
                            4 => "M&#46; Camafort"
                            5 => "L&#46; Mont"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;"
                        "fecha" => "2014"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0445"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mortality after ground-level fall in the elderly patient taking oral anticoagulation for atrial fibrillation&#47;flutter&#58; a long-term analysis of risk versus benefit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "T&#46;S&#46; Inui"
                            1 => "R&#46; Parina"
                            2 => "D&#46;C&#46; Chang"
                            3 => "T&#46;S&#46; Inui"
                            4 => "R&#46; Coimbra"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/TA.0000000000000138"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma Acute Care Surg"
                        "fecha" => "2014"
                        "volumen" => "76"
                        "paginaInicial" => "642"
                        "paginaFinal" => "649"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24553530"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0450"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Systematic review and network meta-analysis comparing antithrombotic agents for the prevention of stroke and major bleeding in patients with atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Cameron"
                            1 => "D&#46; Coyle"
                            2 => "T&#46; Richter"
                            3 => "S&#46; Kelly"
                            4 => "K&#46; Gauthier"
                            5 => "S&#46; Steiner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmjopen-2013-004301"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMJ Open"
                        "fecha" => "2014"
                        "volumen" => "4"
                        "paginaInicial" => "e004301"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24889848"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0455"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk of bleeding with 2 doses of dabigatran compared with warfarin in older and younger patients with atrial fibrillation&#58; an analysis of the randomized evaluation of long-term anticoagulant therapy &#40;RE-LY&#41; trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;W&#46; Eikelboom"
                            1 => "L&#46; Wallentin"
                            2 => "S&#46;J&#46; Connolly"
                            3 => "M&#46; Ezekowitz"
                            4 => "J&#46;S&#46; Healey"
                            5 => "J&#46; Oldgren"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.110.004747"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2011"
                        "volumen" => "123"
                        "paginaInicial" => "2363"
                        "paginaFinal" => "2372"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21576658"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0460"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impaired renal function and bleeding in elderly treated with dabigatran"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E&#46; Berthelot"
                            1 => "C&#46; Lavenu-Bombled"
                            2 => "L&#46; Orostegui-Giron"
                            3 => "C&#46; Desconclois"
                            4 => "P&#46; Assayag"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MBC.0000000000000077"
                      "Revista" => array:6 [
                        "tituloSerie" => "Blood Coagul&#46; Fibrinolysis"
                        "fecha" => "2014"
                        "volumen" => "25"
                        "paginaInicial" => "618"
                        "paginaFinal" => "620"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24509332"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0465"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy and safety of rivaroxaban compared with warfarin among elderly patients with nonvalvular atrial fibrillation in the ROCKET AF trial"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "on behalf of the ROCKET AF Steering Committee and Investigators"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;L&#46; Halperin"
                            1 => "G&#46;J&#46; Hankey"
                            2 => "D&#46;M&#46; Wojdyla"
                            3 => "J&#46;P&#46; Piccini"
                            4 => "Y&#46; Lokhnygina"
                            5 => "M&#46;R&#46; Patel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.113.005008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2014"
                        "volumen" => "130"
                        "paginaInicial" => "138"
                        "paginaFinal" => "146"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24895454"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0470"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy and safety of apixaban compared with warfarin according to age for stroke prevention in atrial fibrillation&#58; observations from the ARISTOTLE trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Halvorsen"
                            1 => "D&#46; Atar"
                            2 => "H&#46; Yang"
                            3 => "R&#46; de Caterina"
                            4 => "C&#46; Erol"
                            5 => "D&#46; Garcia"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehu046"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2014"
                        "volumen" => "35"
                        "paginaInicial" => "1864"
                        "paginaFinal" => "1872"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24561548"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0475"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "New oral anticoagulants in elderly adults&#58; evidence from a meta-analysis of randomized trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46; Sardar"
                            1 => "S&#46; Chatterjee"
                            2 => "S&#46; Chaudhari"
                            3 => "G&#46;Y&#46; Lip"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jgs.12799"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Geriatr Soc"
                        "fecha" => "2014"
                        "volumen" => "62"
                        "paginaInicial" => "857"
                        "paginaFinal" => "864"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24786913"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0480"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Edoxaban versus warfarin in patients with atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "ENGAGE AF-TIMI 48 Investigators"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;P&#46; Giugliano"
                            1 => "C&#46;T&#46; Ruff"
                            2 => "E&#46; Braunwald"
                            3 => "S&#46;A&#46; Murphy"
                            4 => "S&#46;D&#46; Wiviott"
                            5 => "J&#46;L&#46; Halperin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1310907"
                      "Revista" => array:7 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2013"
                        "volumen" => "369"
                        "paginaInicial" => "2093"
                        "paginaFinal" => "2104"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24251359"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0749806307010420"
                          "estado" => "S300"
                          "issn" => "07498063"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib0485"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "European Medicines Agency &#40;EMA&#41;&#46; Pradaxa<span class="elsevierStyleSup">&#174;</span>&#46; Resumen de las caracter&#237;sticas del producto&#46; Available from&#58; <a href="http://www.ema.europa.eu/docs/es_ES/document_library/EPAR_-_Product_Information/human/000829/WC500041059.pdf">http&#58;&#47;&#47;www&#46;ema&#46;europa&#46;eu&#47;docs&#47;es&#95;ES&#47;document&#95;library&#47;EPAR&#95;-&#95;Product&#95;Information&#47;human&#47;000829&#47;WC500041059&#46;pdf</a> &#91;accessed 24&#46;10&#46;14&#93;"
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib0490"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "European Medicines Agency &#40;EMA&#41;&#46; Xarelto<span class="elsevierStyleSup">&#174;</span>&#46; Resumen de las caracter&#237;sticas del producto&#46; Available from&#58; <a href="http://www.ema.europa.eu/docs/es_ES/document_library/EPAR_-_Product_Information/human/000944/WC500057108.pdf">http&#58;&#47;&#47;www&#46;ema&#46;europa&#46;eu&#47;docs&#47;es&#95;ES&#47;document&#95;library&#47;EPAR&#95;-&#95;Product&#95;Information&#47;human&#47;000944&#47;WC500057108&#46;pdf</a> &#91;accessed 08&#46;10&#46;14&#93;"
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib0495"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "European Medicines Agency &#40;EMA&#41;&#46; Eliquis<span class="elsevierStyleSup">&#174;</span>&#46; Resumen de las caracter&#237;sticas del producto&#46; Available from&#58; <a href="http://www.ema.europa.eu/docs/es_ES/document_library/EPAR_-_Product_Information/human/002148/WC500107728.pdf">http&#58;&#47;&#47;www&#46;ema&#46;europa&#46;eu&#47;docs&#47;es&#95;ES&#47;document&#95;library&#47;EPAR&#95;-&#95;Product&#95;Information&#47;human&#47;002148&#47;WC500107728&#46;pdf</a> &#91;accessed 29&#46;09&#46;14&#93;"
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib0500"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines for the primary prevention of stroke&#58; a guideline for healthcare professionals from the American Heart Association&#47;American Stroke Association"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46;B&#46; Goldstein"
                            1 => "C&#46;D&#46; Bushnell"
                            2 => "R&#46;J&#46; Adams"
                            3 => "L&#46;J&#46; Appel"
                            4 => "L&#46;T&#46; Braun"
                            5 => "S&#46; Chaturvedi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/STR.0b013e3181fcb238"
                      "Revista" => array:6 [
                        "tituloSerie" => "Stroke"
                        "fecha" => "2011"
                        "volumen" => "42"
                        "paginaInicial" => "517"
                        "paginaFinal" => "584"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21127304"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib0505"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Focused 2012 update of the Canadian Cardiovascular Society atrial fibrillation guidelines&#58; recommendations for stroke prevention and rate&#47;rhythm control"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;C&#46; Skanes"
                            1 => "J&#46;S&#46; Healey"
                            2 => "J&#46;A&#46; Cairns"
                            3 => "P&#46; Dorian"
                            4 => "A&#46;M&#46; Gillis"
                            5 => "M&#46;S&#46; McMurtry"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.cjca.2012.01.021"
                      "Revista" => array:6 [
                        "tituloSerie" => "Can J Cardiol"
                        "fecha" => "2012"
                        "volumen" => "28"
                        "paginaInicial" => "125"
                        "paginaFinal" => "136"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22433576"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib0510"
              "etiqueta" => "48"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antithrombotic therapy for atrial fibrillation&#58; antithrombotic therapy and prevention of thrombosis&#44; 9th ed&#58; American College of Chest Physicians Evidence-Based Clinical Practice Guidelines"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;J&#46; You"
                            1 => "D&#46;E&#46; Singer"
                            2 => "P&#46;A&#46; Howard"
                            3 => "D&#46;A&#46; Lane"
                            4 => "M&#46;H&#46; Eckman"
                            5 => "M&#46;C&#46; Fang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.11-3192"
                      "Revista" => array:5 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2012"
                        "volumen" => "141"
                        "numero" => "2 Suppl&#46;"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22396557"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib0515"
              "etiqueta" => "49"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46; Heidbuchel"
                            1 => "P&#46; Verhamme"
                            2 => "M&#46; Alings"
                            3 => "M&#46; Antz"
                            4 => "W&#46; Hacke"
                            5 => "J&#46; Oldgren"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/europace/eut083"
                      "Revista" => array:7 [
                        "tituloSerie" => "Europace"
                        "fecha" => "2013"
                        "volumen" => "15"
                        "paginaInicial" => "625"
                        "paginaFinal" => "651"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23625942"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1058274610003836"
                          "estado" => "S300"
                          "issn" => "10582746"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            49 => array:3 [
              "identificador" => "bib0520"
              "etiqueta" => "50"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gu&#237;a para el tratamiento preventivo del ictus isqu&#233;mico y AIT &#40;II&#41;&#46; Recomendaciones seg&#250;n subtipo etiol&#243;gico"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; Fuentes"
                            1 => "J&#46; G&#225;llego"
                            2 => "A&#46; Gil-Nu&#241;ez"
                            3 => "A&#46; Morales"
                            4 => "F&#46; Purroy"
                            5 => "J&#46; Roquer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.nrl.2011.06.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurologia"
                        "fecha" => "2014"
                        "volumen" => "29"
                        "paginaInicial" => "168"
                        "paginaFinal" => "183"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21937151"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            50 => array:3 [
              "identificador" => "bib0525"
              "etiqueta" => "51"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;T&#46; January"
                            1 => "L&#46;S&#46; Wann"
                            2 => "J&#46;S&#46; Alpert"
                            3 => "H&#46; Calkins"
                            4 => "J&#46;C&#46; Cleveland Jr&#46;"
                            5 => "J&#46;E&#46; Cigarroa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2014"
                        "paginaInicial" => "2071"
                        "paginaFinal" => "2104"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            51 => array:3 [
              "identificador" => "bib0530"
              "etiqueta" => "52"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Summary of evidence-based guideline update&#58; prevention of stroke in nonvalvular atrial fibrillation&#58; report of the Guideline Development Subcommittee of the American Academy of Neurology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Culebras"
                            1 => "S&#46;R&#46; Mess&#233;"
                            2 => "S&#46; Chaturvedi"
                            3 => "C&#46;S&#46; Kase"
                            4 => "G&#46; Gronseth"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1212/WNL.0000000000000145"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurology"
                        "fecha" => "2014"
                        "volumen" => "82"
                        "paginaInicial" => "716"
                        "paginaFinal" => "724"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24566225"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            52 => array:3 [
              "identificador" => "bib0535"
              "etiqueta" => "53"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Atrial fibrillation&#58; the management of atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "National Institute for Health and Clinical Excellence &#40;NICE&#41;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2014&#44; June"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            53 => array:3 [
              "identificador" => "bib0540"
              "etiqueta" => "54"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Situaci&#243;n del tratamiento anticoagulante oral en pacientes con fibrilaci&#243;n auricular no valvular en Espa&#241;a&#46; Estudio REACT-AF"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "F&#46; De Andr&#233;s-Nogales"
                            1 => "I&#46; Oyag&#252;ez"
                            2 => "L&#46; Beteg&#243;n-Nicol&#225;s"
                            3 => "C&#46; Canal-Fontcuberta"
                            4 => "J&#46; Soto-&#193;lvarez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Rev Clin Esp"
                        "fecha" => "2015"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/22548874/0000021500000003/v1_201504010033/S2254887415000144/v1_201504010033/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "1904"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Clinical Up-Date"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/22548874/0000021500000003/v1_201504010033/S2254887415000144/v1_201504010033/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887415000144?idApp=WRCEE"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Clinical up-date
Antithrombotic treatment in elderly patients with atrial fibrillation
Tratamiento antitrombótico en el paciente anciano con fibrilación auricular
C. Suárez Fernándeza,
Corresponding author
csuarezf@salud.madrid.org

Corresponding author.
, M. Camafortb, J.M. Cepeda Rodrigoc, J. Díez-Manglanod, F. Formigae, A. Pose Reinof, G. Tiberiog, J.M. Mostazah, on behalf of Grupo de Trabajo de Riesgo Vascular de la SEMI
a Hospital Universitario de La Princesa, Grupo de Riesgo Vascular de la SEMI, Madrid, Spain
b Hospital Clinic de Barcelona, Grupo de Riesgo Vascular de la SEMI, Barcelona, Spain
c Hospital Vega Baja de Orihuela, Grupo de Riesgo Vascular de la SEMI, Orihuela, Alicante, Spain
d Hospital Royo Villanova, Grupo de Riesgo Vascular de la SEMI, Zaragoza, Spain
e Hospital Universitari de Bellvitge, Grupo de Riesgo Vascular de la SEMI, Hospitalet de Llobregat, Barcelona, Spain
f Complexo Hospitalario Universitario de Santiago, Grupo de Riesgo Vascular de la SEMI, Santiago de Compostela, Spain
g Hospital Virgen del Camino, Grupo de Riesgo Vascular de la SEMI, Pamplona, Spain
h Hospital Carlos III, Grupo de Riesgo Vascular de la SEMI, Madrid, Spain
Read
123
Times
was read the article
10
Total PDF
113
Total HTML
Share statistics
 array:21 [
  "pii" => "S2254887415000144"
  "issn" => "22548874"
  "doi" => "10.1016/j.rceng.2014.11.005"
  "estado" => "S300"
  "fechaPublicacion" => "2015-04-01"
  "aid" => "1087"
  "copyrightAnyo" => "2015"
  "documento" => "simple-article"
  "subdocumento" => "crp"
  "cita" => "Rev Clin Esp. 2015;215:171-81"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 114
    "formatos" => array:2 [
      "HTML" => 108
      "PDF" => 6
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:18 [
      "pii" => "S0014256514004470"
      "issn" => "00142565"
      "doi" => "10.1016/j.rce.2014.11.024"
      "estado" => "S300"
      "fechaPublicacion" => "2015-04-01"
      "aid" => "1087"
      "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; y Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
      "documento" => "simple-article"
      "subdocumento" => "crp"
      "cita" => "Rev Clin Esp. 2015;215:171-81"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 1206
        "formatos" => array:2 [
          "HTML" => 1094
          "PDF" => 112
        ]
      ]
      "es" => array:12 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Actualizaci&#243;n Cl&#237;nica</span>"
        "titulo" => "Tratamiento antitromb&#243;tico en el paciente anciano con fibrilaci&#243;n auricular"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "171"
            "paginaFinal" => "181"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Antithrombotic Treatment in Elderly Patients with Atrial Fibrillation"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "C&#46; Su&#225;rez Fern&#225;ndez, M&#46; Camafort, J&#46;M&#46; Cepeda Rodrigo, J&#46; D&#237;ez-Manglano, F&#46; Formiga, A&#46; Pose Reino, G&#46; Tiberio, J&#46;M&#46; Mostaza"
            "autores" => array:9 [
              0 => array:2 [
                "nombre" => "C&#46;"
                "apellidos" => "Su&#225;rez Fern&#225;ndez"
              ]
              1 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Camafort"
              ]
              2 => array:2 [
                "nombre" => "J&#46;M&#46;"
                "apellidos" => "Cepeda Rodrigo"
              ]
              3 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "D&#237;ez-Manglano"
              ]
              4 => array:2 [
                "nombre" => "F&#46;"
                "apellidos" => "Formiga"
              ]
              5 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Pose Reino"
              ]
              6 => array:2 [
                "nombre" => "G&#46;"
                "apellidos" => "Tiberio"
              ]
              7 => array:2 [
                "nombre" => "J&#46;M&#46;"
                "apellidos" => "Mostaza"
              ]
              8 => array:1 [
                "colaborador" => "en nombre del Grupo de Trabajo de Riesgo Vascular de la SEMI"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2254887415000144"
          "doi" => "10.1016/j.rceng.2014.11.005"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887415000144?idApp=WRCEE"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256514004470?idApp=WRCEE"
      "url" => "/00142565/0000021500000003/v1_201504010035/S0014256514004470/v1_201504010035/es/main.assets"
    ]
  ]
  "itemAnterior" => array:18 [
    "pii" => "S2254887414001465"
    "issn" => "22548874"
    "doi" => "10.1016/j.rceng.2014.12.001"
    "estado" => "S300"
    "fechaPublicacion" => "2015-04-01"
    "aid" => "1055"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
    "documento" => "article"
    "subdocumento" => "fla"
    "cita" => "Rev Clin Esp. 2015;215:156-64"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 162
      "formatos" => array:2 [
        "HTML" => 161
        "PDF" => 1
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Prevalence of depression in type 2 diabetes mellitus"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "156"
          "paginaFinal" => "164"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Prevalencia de la depresi&#243;n en la diabetes mellitus tipo 2"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 955
              "Ancho" => 1609
              "Tamanyo" => 55356
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Prevalence of depression in patients with type 2 diabetes mellitus&#44; as a function of age and sex&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46;L&#46; Rodr&#237;guez Calv&#237;n, A&#46; Zapatero Gaviria, M&#46;D&#46; Mart&#237;n R&#237;os"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "J&#46;L&#46;"
              "apellidos" => "Rodr&#237;guez Calv&#237;n"
            ]
            1 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Zapatero Gaviria"
            ]
            2 => array:2 [
              "nombre" => "M&#46;D&#46;"
              "apellidos" => "Mart&#237;n R&#237;os"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S001425651400410X"
        "doi" => "10.1016/j.rce.2014.10.010"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S001425651400410X?idApp=WRCEE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887414001465?idApp=WRCEE"
    "url" => "/22548874/0000021500000003/v1_201504010033/S2254887414001465/v1_201504010033/en/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Clinical up-date</span>"
    "titulo" => "Antithrombotic treatment in elderly patients with atrial fibrillation"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "171"
        "paginaFinal" => "181"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "C&#46; Su&#225;rez Fern&#225;ndez, M&#46; Camafort, J&#46;M&#46; Cepeda Rodrigo, J&#46; D&#237;ez-Manglano, F&#46; Formiga, A&#46; Pose Reino, G&#46; Tiberio, J&#46;M&#46; Mostaza"
        "autores" => array:9 [
          0 => array:4 [
            "nombre" => "C&#46;"
            "apellidos" => "Su&#225;rez Fern&#225;ndez"
            "email" => array:1 [
              0 => "csuarezf&#64;salud&#46;madrid&#46;org"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Camafort"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "J&#46;M&#46;"
            "apellidos" => "Cepeda Rodrigo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "J&#46;"
            "apellidos" => "D&#237;ez-Manglano"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "F&#46;"
            "apellidos" => "Formiga"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "Pose Reino"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "aff0030"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "G&#46;"
            "apellidos" => "Tiberio"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">g</span>"
                "identificador" => "aff0035"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "J&#46;M&#46;"
            "apellidos" => "Mostaza"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">h</span>"
                "identificador" => "aff0040"
              ]
            ]
          ]
          8 => array:1 [
            "colaborador" => "on behalf of Grupo de Trabajo de Riesgo Vascular de la SEMI"
          ]
        ]
        "afiliaciones" => array:8 [
          0 => array:3 [
            "entidad" => "Hospital Universitario de La Princesa&#44; Grupo de Riesgo Vascular de la SEMI&#44; Madrid&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Hospital Clinic de Barcelona&#44; Grupo de Riesgo Vascular de la SEMI&#44; Barcelona&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Hospital Vega Baja de Orihuela&#44; Grupo de Riesgo Vascular de la SEMI&#44; Orihuela&#44; Alicante&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Hospital Royo Villanova&#44; Grupo de Riesgo Vascular de la SEMI&#44; Zaragoza&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Hospital Universitari de Bellvitge&#44; Grupo de Riesgo Vascular de la SEMI&#44; Hospitalet de Llobregat&#44; Barcelona&#44; Spain"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
          5 => array:3 [
            "entidad" => "Complexo Hospitalario Universitario de Santiago&#44; Grupo de Riesgo Vascular de la SEMI&#44; Santiago de Compostela&#44; Spain"
            "etiqueta" => "f"
            "identificador" => "aff0030"
          ]
          6 => array:3 [
            "entidad" => "Hospital Virgen del Camino&#44; Grupo de Riesgo Vascular de la SEMI&#44; Pamplona&#44; Spain"
            "etiqueta" => "g"
            "identificador" => "aff0035"
          ]
          7 => array:3 [
            "entidad" => "Hospital Carlos III&#44; Grupo de Riesgo Vascular de la SEMI&#44; Madrid&#44; Spain"
            "etiqueta" => "h"
            "identificador" => "aff0040"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Tratamiento antitromb&#243;tico en el paciente anciano con fibrilaci&#243;n auricular"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Case report</span><p id="par0005" class="elsevierStylePara elsevierViewall">An 83-year-old man&#44; with arterial hypertension and diabetes&#44; experienced a hip fracture 2 months ago due to an accidental fall&#44; which was treated with a total hip prosthesis&#46; The patient was treated with 50<span class="elsevierStyleHsp" style=""></span>mg&#47;day of losartan&#44; 5<span class="elsevierStyleHsp" style=""></span>mg&#47;day of amlodipine and 850<span class="elsevierStyleHsp" style=""></span>mg&#47;day of metformin&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">During a routine examination&#44; the attending physician detected atrial fibrillation of uncertain origin&#46; The patient was asymptomatic from a cardiology standpoint&#46; The physical examination was anodyne&#44; although arrhythmia was detected in the auscultation&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Due to the recent fall&#44; the decision was made to anticoagulate the patient with acetylsalicylic acid &#40;100<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#46; Three months later&#44; the patient was admitted to the hospital with a stroke&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">The clinical problem</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Epidemiological aspects</span><p id="par0020" class="elsevierStylePara elsevierViewall">Atrial fibrillation &#40;AF&#41; is the most common type of arrhythmia in clinical practice&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">1</span></a> The Anticoagulation and Risk Factors in Atrial Fibrillation &#40;ATRIA&#41; study&#44; conducted in the United States&#44; observed that AF affects approximately 1&#37; of the general population&#44; although this percentage increases with age from 0&#46;1&#37; in participants younger than 55 years to 9&#37; in those participants aged 80 years or more&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">2</span></a> The same trend has been observed in Europe&#59; it has been estimated that the prevalence of AF is less than 1&#37; in participants aged 55&#8211;59 years and approximately 18&#37; in those who are at least 85 years of age&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">3</span></a> The VAL-FAAP study analyzed approximately 120&#44;000 participants treated in primary care in Spain&#46; The prevalence of AF was 6&#46;1&#37;&#44; a figure that increased with age from somewhat less than 1&#37; in participants younger than 50 years to 17&#46;6&#37; for those 80 years or older&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">4</span></a> In the Observation of Atrial Fibrillation and Coronary Disease in Spain &#40;<span class="elsevierStyleItalic">Observaci&#243;n de Fibrilaci&#243;n Auricular y Enfermedad Coronaria en Espa&#241;a</span>&#44; OFRECE&#41; study that analyzed participants 40 years of age and older treated in primary care&#44; the prevalence of AF was 4&#46;4&#37; and progressively increased starting at 60 years of age&#44; reaching 17&#46;7&#37; in those older than 80 years&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">5</span></a> In the DARIOS study that analyzed 6 population-based studies&#44; the prevalence of AF was 1&#46;5&#37;&#44; a figure that increased with the age&#44; up to 6&#46;3&#37; in those older than 75 years&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">6</span></a> Data from the ESFINGE study show that a third of patients older than 70 years hospitalized in the national departments of internal medicine have AF&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The prevalence of AF not only increases with age but also with the presence of other associated comorbidities&#44; such as ischemic heart disease and heart failure&#44; conditions that are also more prevalent in advanced ages&#46;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">8&#44;9</span></a> Due to the progressive aging of the population&#44; both the prevalence and incidence of AF has increased markedly in recent years&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">1&#44;10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">AF increases the risk of stroke by up to 5-fold&#46; More than 15&#37; of stroke episodes are due to AF &#40;36&#37; in individuals older than 80 years&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">9</span></a> Additionally&#44; stroke associated with AF&#44; when compared with stroke unrelated to AF&#44; has higher morbidity and mortality and causes more sequela and hospitalizations&#44; especially in the elderly&#46;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">11&#8211;14</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In the elderly population&#44; the treatment objectives for patients with AF should be focused on preventing complications related to the presence of this arrhythmia&#44; especially stroke&#44; as well as on improving quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">12</span></a> In this context&#44; anticoagulation plays a fundamental role&#46; However&#44; it is particularly important with the elderly population to balance the risk of both stroke and bleeding&#44; given that both are increased in these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">12</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The objective of this update was to review the specific comments by the clinical practice guidelines on antithrombotic treatment in elderly patients with nonvalvular AF &#40;NVAF&#41;&#46; It is important to emphasize that the definition of the elderly patient has changed over time&#46; Although in the past elderly patients were considered those aged 65 years or older&#44; the various current clinical practice guidelines and the studies performed with direct oral anticoagulants have raised this cutoff to 75 years&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Clinical profile of elderly patients with atrial fibrillation</span><p id="par0045" class="elsevierStylePara elsevierViewall">The management of elderly patients with AF is complex due to&#44; among other things&#44; their considerable number of comorbidities&#44; which often result in polymedication&#46; Thus&#44; it has been observed among patients with hypertension and chronic ischemic heart disease that those with AF are older and more often present diabetes&#44; left ventricular hypertrophy&#44; heart failure&#44; peripheral arterial disease&#44; renal failure and stroke&#44; when compared with those in sinus rhythm&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">9</span></a> Moreover&#44; it appears that patients with AF have an increased risk of dementia&#44; particularly those with a history of stroke&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">15</span></a> In fact&#44; there are various peculiarities in the elderly that confer a condition of frailty&#46; Physical and mental abnormalities are common&#44; especially cognitive and mood disorders&#44; risk of falls&#44; malnutrition and social dependence&#44; which have a significant impact on the management of these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">12</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Advanced age is itself an independent predictor of both stroke and mortality after the stroke&#44; as well as the risk of bleeding&#46;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">16&#8211;20</span></a> This aspect is considered in the risk scales&#46; On the CHADS<span class="elsevierStyleInf">2</span> scale&#44; an age &#8805;75 years scores 1 point&#44; reinforcing the increase in risk with increasing age&#46; For the CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc scale&#44; an age between 65 and 74 years is awarded 1 point&#44; increasing to 2 for ages &#62;75 years&#46; In terms of the risk of bleeding&#44; an age &#62;65 years scores 1 point on the HAS-BLED &#40;Hypertension&#44; Abnormal Renal&#47;Liver Function&#44; Stroke&#44; Bleeding History or Predisposition&#44; Labile INR&#44; Elderly&#44; Drugs&#47;Alcohol Concomitantly&#41; scale&#46;<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">17&#8211;20</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Consequently&#44; taking into account the above described determinants&#44; it is especially important for elderly patients to not only balance the risk of stroke with that of hemorrhage but also to assess the possibility of properly taking medication&#44; the availability of a caregiver&#44; the social support&#44; etc&#46;<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">12&#44;21</span></a> In principle&#44; except when the patient has a high risk of bleeding&#44; the considerable majority of elderly patients with NVAF should undergo permanent anticoagulation&#46; Nevertheless&#44; the Birmingham Atrial Fibrillation Treatment of the Aged &#40;BAFTA&#41; study found no evidence that&#44; when compared with acetylsalicylic acid&#44; anticoagulation provided clinically relevant protection against cognitive impairment in patients after 33 months of treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">22</span></a> A decision algorithm has recently been proposed for better profiling geriatric patients with NVAF who will most benefit from treatment with vitamin K antagonists&#46; The algorithm includes 6 items &#40;previous bleeding with vitamin K antagonists&#44; degree of autonomy&#44; mini mental state examination &#91;MMSE&#93; score&#44; risk of falls and comorbidity index&#41;&#46; Each variable has a score &#40;0&#44; 0&#46;5 and 1 point&#41; according to the intensity &#40;mild&#44; moderate or high&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">23</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes the peculiarities of AF in this age group&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Strategies and evidence</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Anticoagulation with vitamin K antagonists for elderly patients</span><p id="par0065" class="elsevierStylePara elsevierViewall">Traditionally&#44; anticoagulation for patients with AF has been performed with vitamin K antagonists&#46; In fact&#44; it has been shown that anticoagulant therapy with vitamin K antagonists is an effective treatment for the prevention of stroke and thromboembolism when compared with antiplatelet agents&#44; including acetylsalicylic acid&#46;<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">24&#44;25</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Anticoagulant treatment with vitamin K antagonists is also beneficial for the elderly population&#46; The BAFTA study compared warfarin treatment with acetylsalicylic acid treatment &#40;75<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#44; with approximately 1000 participants 75 years of age or older with AF who were followed-up for a mean time of 2&#46;7 years&#46; The warfarin treatment was associated with a significant reduction &#40;52&#37;&#41; in the risk of fatal or debilitating stroke&#44; intracranial hemorrhage and clinically significant arterial embolism&#44; with no significant differences in the risk of extracranial hemorrhage&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">26</span></a> Subsequent studies have confirmed the benefits of anticoagulation in this population&#46;<a class="elsevierStyleCrossRefs" href="#bib0405"><span class="elsevierStyleSup">27&#44;28</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Although it is certain that the risk of bleeding is increased in elderly patients&#44;<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">19&#44;29</span></a> permanent anticoagulation is indicated for the majority of elderly patients with AF&#46; However&#44; the reality is that a significant number of patients who have an indication for anticoagulation do not receive it&#44; precisely because of the fear of bleeding&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">9&#44;30&#8211;34</span></a> In a study performed with approximately 600 participants with NVAF&#44; only 34&#37; of the participants were treated with anticoagulation at discharge&#46; This percentage was even lower for the more elderly participants &#40;42&#37; among individuals aged 65&#8211;75 years and 29&#37; for those older than 75 years&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">31</span></a> In addition to bleeding&#44; the factors that promote this situation include falls&#44; which should never be an absolute contraindication for anticoagulation&#46; However&#44; given that frequent falls in elderly patients with AF are associated with higher mortality&#44; in the patient group with a lower CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc score &#40;e&#46;g&#46;&#44; 0&#8211;3&#41;&#44; the decision to provide anticoagulation therapy to the patient should be made by carefully assessing the risk&#47;benefit ratio&#46;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">35</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Vitamin K antagonists have certain limitations&#44; such as their narrow therapeutic window&#44; variable anticoagulant response&#44; interactions with food and other drugs and a slow start and end of action&#44; which require the implementation of periodic checkups and frequent dosage adjustments &#40;more common in the elderly&#41;&#46; These limitations undoubtedly contribute to the underutilization of these drugs in clinical practice&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">4</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Direct oral anticoagulants in elderly patients</span><p id="par0085" class="elsevierStylePara elsevierViewall">Direct oral anticoagulants &#40;dabigatran&#44; rivaroxaban&#44; apixaban and&#44; more recently&#44; edoxaban&#41; have at least a similar efficacy as warfarin in preventing stroke and systemic embolism but have a better safety profile&#44; mainly due to the lower risk of intracranial hemorrhage for patients with NVAF&#46; In addition to having predictable kinetics and a broad therapeutic window&#44; these anticoagulants can be prescribed at a fixed dosage&#44; without the need for periodic checkups&#46;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">36</span></a> Clinical trials specifically designed to assess the safety and efficacy of these drugs in elderly populations have unfortunately not been performed&#46; However&#44; in recent years&#44; various subanalyses have been published on the safety and efficacy of direct oral anticoagulants by age&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In the RE-LY study that compared dabigatran to warfarin&#44; both dabigatran dosages had a lower risk of both intracranial and extracranial bleeding in the participants younger than 75 years&#46; The patients aged 75 years or older had less frequent intracranial bleeding&#44; but the extracranial bleeding was equal or more frequent&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">37</span></a> Given that the elimination of dabigatran is performed mainly by the kidneys and that the elderly frequently have renal failure&#44; close monitoring of renal function is important for these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">38</span></a> Although the standard recommended dosage for dabigatran is 150<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h&#44; it is recommended that the dosage be reduced to 110<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h for patients aged 80 years or older&#46; For patients aged 75&#8211;80 years or with moderate renal failure&#44; the dosage is selected depending on the risk of stroke&#47;bleeding&#46; In the ROCKET-AF study &#40;An Efficacy and Safety Study of Rivaroxaban With Warfarin for the Prevention of Stroke and Non-Central Nervous System Systemic Embolism in Patients With Non-Valvular Atrial Fibrillation&#41; that compared warfarin to rivaroxaban&#44; the efficacy &#40;risk of stroke and systemic embolism&#41; and safety &#40;risk of major bleeding&#41; of rivaroxaban were consistent with the overall study results&#44; regardless of age&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">39</span></a> In the Apixaban for the Prevention of Stroke in Subjects With Atrial Fibrillation &#40;ARISTOTLE&#41; study&#44; apixaban was more effective in reducing the risk of stroke and mortality&#44; with fewer major bleeding episodes&#44; total bleeding episodes and intracranial bleeding episodes&#44; regardless of age&#44; including with patients aged 80 years or older&#46;<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">40</span></a> In a recent meta-analyses of patients aged 75 years or older enrolled in clinical trials performed with rivaroxaban&#44; apixaban and dabigatran&#44; the direct oral anticoagulants as a whole were more effective than standard treatment in the prevention of stroke and systemic embolism&#46;<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">41</span></a> In the ENGAGE AF-TIMI 48 study&#44; both edoxaban dosages were noninferior to warfarin with respect to preventing stroke and systemic embolism but had fewer major bleeding episodes&#44; regardless of age &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">42</span></a><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows how the dosage adjustments for dabigatran&#44; rivaroxaban and apixaban should be performed for patients with NVAF&#44; depending on age&#44; renal function and weight&#46;<a class="elsevierStyleCrossRefs" href="#bib0485"><span class="elsevierStyleSup">43&#8211;45</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Controversy and issues to be resolved</span><p id="par0095" class="elsevierStylePara elsevierViewall">Despite the recent proliferation of guidelines that&#44; to various degrees&#44; refer to the elderly&#44; the evidence in this population group is scarce&#44; and there are a number of unresolved issues that are frequently faced by clinicians in their daily practice&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">A number of these issues are examined below&#46; The major advantage of direct oral anticoagulants is the reduction in intracranial hemorrhage&#46; In addition&#44; there are data from neuroimaging tests &#40;e&#46;g&#46;&#44; microinfarctions&#44; leukoaraiosis&#44; and microhemorrhages&#41; that are associated with an increased risk of intracranial hemorrhage&#44; particularly in cases where there is a history of ischemic stroke&#46; Given this&#44; should a brain CT scan&#47;MRI be performed for elderly patients with an indication of anticoagulation&#44; due to their greater risk of bleeding and high prevalence of the previously mentioned lesion&#63; What type of antithrombotic treatment is the treatment of choice for an elderly patient with a history of frequent falls&#63; In what way does cognitive impairment determine the indication and type of antithrombotic treatment in elderly patients with AF&#63; How often and under what circumstances should renal function be monitored in elderly patients undergoing anticoagulation&#63; Under what circumstances is the temporary or definitive withdrawal of anticoagulation recommended for the elderly&#63; How should antithrombotic treatment be managed for patients with a high risk of gastrointestinal bleeding&#63; How does polypharmacy and poorer treatment compliance influence the choice of anticoagulant treatment for the elderly&#63; How should weight and frailty affect the dosage of direct oral anticoagulants in elderly patients&#63; Are there sufficient data on their safety and efficacy to recommend direct oral anticoagulants to very elderly patients&#63; The answers to these questions will probably only be found when sufficient experience in the real world is available&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">What do the clinical practice guidelines say on this matter&#63;</span><p id="par0105" class="elsevierStylePara elsevierViewall">In recent years&#44; various clinical practice guidelines have been published on managing patients with AF&#46; Although the recommendations are generally given regardless of age&#44; a number have specific comments on elderly populations&#44; which we will review below&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">In 2010&#44; the European Society of Cardiology published guidelines for the management of patients with AF&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">17</span></a> These guidelines dedicate a specific paragraph to elderly populations&#46; Among other issues&#44; the guidelines state that AF is more common the older the patient and provide the clinical characteristics of this population&#46; Furthermore&#44; the guidelines emphasize that a strategy of heart rate control is preferable to rhythm control in the elderly population&#46; For the risk stratification of stroke and bleeding&#44; the guidelines propose the use of the CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc and HAS-BLED scales&#46; Unless contraindicated&#44; anticoagulation is recommended&#46; The benefit of antiplatelet treatment is highly limited in this population&#44; given that the risk of major bleeding episodes is very similar to that of anticoagulation&#44; while antiplatelet treatment is much less effective in terms of preventing stroke and cardiovascular events&#46; It has been suggested that an international normalized ratio &#40;INR&#41; range between 1&#46;8 and 2&#46;5 would be safer for the elderly population who undergo anticoagulation with vitamin K antagonists&#46; However&#44; the reality is that this range has not been endorsed by any clinical trial&#46; Cohort studies have suggested an increased risk of stroke with an INR range of 1&#46;5&#8211;2&#46;0&#59; therefore&#44; it is recommended that the INR not fall below 2&#46;0&#46; Only RE-LY study data have been published and the European Medicines Agency &#40;EMA&#44; <a href="http://www.ema.europa.eu/">http&#58;&#47;&#47;www&#46;ema&#46;europa&#46;eu&#47;</a>&#41; has not approved the use of vitamin K in patients with NVAF&#46; However these guidelines recommend the use of vitamin K antagonists&#44; although they make a number of general recommendations on the use of dabigatran &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">17</span></a></p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">The update to these guidelines was published in 2012&#46; These guidelines continue to recommend the use of the CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc and Has-BLED scales and emphasize the lack of benefit from acetylsalicylic acid&#46; They also comment on the results of 3 clinical trials with direct oral anticoagulants &#40;RE-LY&#44; ROCKET-AF and ARISTOTLE&#41; and the concern regarding its applicability to more elderly populations&#46; For patients aged 80 years and older&#44; the dabigatran dosage to be used is 110<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">18</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">The proposed guidelines by the American Heart Association and the American Stroke Association for the primary prevention of stroke emphasize the need to control arterial hypertension in the elderly &#40;mainly systolic blood pressure&#41;&#44; which&#44; along with appropriate antithrombotic treatment&#44; are essential for preventing the development of stroke in patients with AF&#46; In most elderly patients with stable ischemic heart disease and AF&#44; anticoagulant treatment is sufficient&#46; Moreover&#44; the detection of brain microhemorrhages in MRI could be useful when assessing the safety of antithrombotic treatment in an elderly patient &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">46</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">The 2012 Canadian AF guidelines indicate that advanced age &#40;&#62;75<span class="elsevierStyleHsp" style=""></span>years&#41; is considered a risk factor not only for stroke but also for hemorrhage&#44; particularly intracranial&#46; The use of the CHADS<span class="elsevierStyleInf">2</span>&#44; CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc and HAS-BLED scales is recommended&#46; With regard to direct oral anticoagulants&#44; dosage reductions are recommended for patients older than 75 years&#44; especially for those older than 80 and especially with dabigatran&#46; Moreover&#44; all patients with AF undergoing treatment with anticoagulants should undergo periodic monitoring of their renal function at least once a year &#40;more frequently in cases of renal failure&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">47</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">The recommendations proposed by the American College of Chest Physicians are not substantially different according to the age&#46; They do however specify that the risk of stroke increases with age&#44; as reflected in the CHADS<span class="elsevierStyleInf">2</span> risk stratification scale&#44; as well as the risk of bleeding &#40;older than 65 years on the HAS-BLED scale&#44; older than 75 years on the HEMORR<span class="elsevierStyleInf">2</span>HAGES scale&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">48</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">The guidelines of the European Heart Rhythm Association&#44; which specifically cover the use of direct oral anticoagulants in patients with NVAF&#44; insist on the need for renal function monitoring&#46; That is especially relevant in elderly patients &#40;older than 75 years&#41; or those who are taking dabigatran&#46; For patients with active cancer&#44; vitamin K antagonists or heparins are preferred over direct oral anticoagulants&#44; given the lack of experience with the latter in this context and possibility of interactions with chemotherapy drugs&#46; In the event that antiplatelet therapy is considered necessary in the first year after an acute ischemic episode&#44; the use of low doses of direct oral anticoagulants is considered safer&#44; especially for patients with HAS-BLED scores &#8805;3&#46; In this context&#44; vitamin K antagonists &#40;INR objective 2&#8211;2&#46;5&#41; might be preferable&#44; especially for very elderly populations and for those with renal failure &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">49</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">The guidelines of the Spanish Society of Neurology recommend anticoagulation&#44; except when contraindicated&#44; for patients with NVAF and a high risk of stroke &#40;patients older than 75 years&#41;&#46; For these patients&#44; both vitamin K antagonists and direct oral anticoagulants may be used&#46; In fact&#44; the guidelines specifically indicate that despite the hemorrhagic risk&#44; oral anticoagulants show a clear benefit in patients older than 85 years who have AF &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">50</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">The guidelines of the American College of Cardiology&#44; American Heart Association and Heart Rhythm Society have been recently published&#46; These guidelines have a specific section dedicated to the elderly population that indicates that the prevalence of AF increases with age and that the presence of other comorbidities is more common&#46; Clinicians usually opt for a heart rate control strategy&#44; more so than a rhythm control strategy&#44; especially considering the possibility of the adverse effects of antiarrhythmic agents in this population&#46; The use of the CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc scale is recommended&#44; as well as anticoagulation&#44; for patients aged 75 years or older&#44; either with vitamin K antagonists or direct oral anticoagulants&#44; except where contraindicated&#46; Patients&#8217; renal function should be measured before starting treatment with direct oral anticoagulants&#44; as well as subsequently during monitoring at least once a year &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">51</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Similarly&#44; guidelines proposed by a subcommittee of the American Academy of Neurology have been recently published&#46; These guidelines recognize the benefit of anticoagulation in elderly patients &#40;older than 75 years&#41;&#46; The main recommendation of these guidelines is that&#44; except where there is recent spontaneous bleeding or intracranial hemorrhage&#44; anticoagulation should be proposed for all elderly patients with NVAF&#44; including patients with mild dementia or occasional falls&#46; However&#44; the benefit of anticoagulation in patients with moderate to severe dementia or with frequent falls is uncertain &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">52</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">The recent NICE guidelines recommend&#44; on one hand&#44; a heart rate control strategy and&#44; on the other&#44; anticoagulation for those participants with NVAF and a CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc score &#8805;2&#46; Apixaban&#44; dabigatran&#44; rivaroxaban and vitamin K antagonists may be used&#46;<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">53</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">In summary&#44; the various clinical practice guidelines as a whole recognize that elderly patients with AF are complex patients with numerous comorbidities and who are frequently polymedicated&#46; All elderly patients with AF should &#40;unless contraindicated&#41; undergo permanent anticoagulant treatment&#44; although it is important to assess the risk of bleeding&#46; In terms of the type of oral anticoagulant to use in the elderly population&#44; both vitamin K antagonists and direct oral anticoagulants may be used in these patients&#46; If the latter are used&#44; it is important that renal function be monitored during follow-up&#44; especially when the patient has known renal failure or is taking dabigatran&#46; Unfortunately and despite the fact that the recommendations of the clinical practice guidelines appear clear&#44; a study performed with patients with NVAF in Spain found that 42&#37; of patients did not follow the recommendations of the European Society of Cardiology&#46;<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">54</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">How should our patient have been evaluated and treated&#63;</span><p id="par0165" class="elsevierStylePara elsevierViewall">Before the stroke&#44; this patient already presented a very high risk of thromboembolic complications &#40;CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc&#58; 4&#59; 2 points for age&#59; 1 point for hypertension and 1 point for diabetes&#41;&#46; The patient should have therefore undergone anticoagulation&#46; The two factors that had the greatest weight for not starting anticoagulation were the history of casual falls and the patient&#39;s age&#44; despite the high thromboembolic risk he had&#44; as subsequently happened&#46; The patient underwent anticoagulation after the stroke&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">In conclusion&#44; the management of NVAF in the elderly is complicated&#44; and&#44; due to the increased risk of thromboembolic complications and hemorrhage&#44; the decision to administer anticoagulation therapy should be individualized&#46; There are still unresolved questions and lack of evidence in this population&#46; Data from observational studies in our standard practice are needed and are important for the decision-making process&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Funding</span><p id="par0175" class="elsevierStylePara elsevierViewall">Editorial assistance was provided by Content Ed Net and sponsored by Bayer&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflicts of interest</span><p id="par0180" class="elsevierStylePara elsevierViewall">Dr&#46; Carmen Su&#225;rez has received has received honoraria for lectures and advising from BMS&#44; Pfizer&#44; Boheringher&#44; Bayer and Daichii Sankyo&#46; Dr&#46; Francesc Formiga has received honoraria for lectures and advising from BMS&#44; Pfizer&#44; Boheringher&#44; Bayer and Daichii Sankyo Dr&#46; A pose Reino declares having received honoraria for lectures and advising from BMS&#44; Pfizer&#44; Boheringher and Bayer&#46; The remaining authors declare having no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:13 [
        0 => array:3 [
          "identificador" => "xres468581"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec491222"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres468582"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec491221"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Case report"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "The clinical problem"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Epidemiological aspects"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Clinical profile of elderly patients with atrial fibrillation"
            ]
          ]
        ]
        6 => array:3 [
          "identificador" => "sec0025"
          "titulo" => "Strategies and evidence"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Anticoagulation with vitamin K antagonists for elderly patients"
            ]
            1 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Direct oral anticoagulants in elderly patients"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Controversy and issues to be resolved"
        ]
        8 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "What do the clinical practice guidelines say on this matter&#63;"
        ]
        9 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "How should our patient have been evaluated and treated&#63;"
        ]
        10 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Funding"
        ]
        11 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Conflicts of interest"
        ]
        12 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-10-10"
    "fechaAceptado" => "2014-11-30"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec491222"
          "palabras" => array:8 [
            0 => "Elderly"
            1 => "Nonvalvular atrial fibrillation"
            2 => "Guidelines"
            3 => "Vitamin K antagonists"
            4 => "Dabigatran"
            5 => "Rivaroxaban"
            6 => "Apixaban"
            7 => "Edoxaban"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec491221"
          "palabras" => array:8 [
            0 => "Anciano"
            1 => "Fibrilaci&#243;n auricular no valvular"
            2 => "Gu&#237;as"
            3 => "Antagonistas de la vitamina K"
            4 => "Dabigatran"
            5 => "Rivaroxaban"
            6 => "Apixaban"
            7 => "Edoxaban"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Atrial fibrillation &#40;AF&#41; in the elderly is a complex condition due to the high number of frequently associated comorbidities&#44; such as cardiovascular and kidney disease&#44; cognitive disorders&#44; falls and polypharmacy&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Except when contraindicated&#44; anticoagulation is necessary for preventing thromboembolic events in this population&#46; Both vitamin K antagonists and direct oral anticoagulants &#40;dabigatran&#44; rivaroxaban and apixaban&#41; are indicated in this context&#46; Renal function should be closely monitored for this age group when these drugs are used&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In recent years&#44; various clinical practice guidelines have been published on patients with AF&#46; The majority of these guidelines make specific recommendations on the clinical characteristics and treatment of elderly patients&#46; In this update&#44; we review the specific comments on the recommendations concerning antithrombotic treatment in elderly patients with nonvalvular AF&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La fibrilaci&#243;n auricular &#40;FA&#41; en el anciano es una entidad compleja debido al elevado n&#250;mero de comorbilidades frecuentemente asociadas&#44; como las enfermedades cardiovasculares y la enfermedad renal&#44; los trastornos cognitivos&#44; las ca&#237;das o la polimedicaci&#243;n&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Excepto cuanto est&#233; contraindicada&#44; la anticoagulaci&#243;n es necesaria para la prevenci&#243;n de los eventos tromboemb&#243;licos en esta poblaci&#243;n&#46; Tanto los antagonistas de la vitamina K como los anticoagulantes orales de acci&#243;n directa &#40;dabigatran&#44; rivaroxaban y apixaban&#41; est&#225;n indicados en este contexto&#46; En este grupo de edad la funci&#243;n renal debe ser estrechamente vigilada cuando se utilizan estos &#250;ltimos&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">En los &#250;ltimos a&#241;os se han publicado diferentes gu&#237;as de pr&#225;ctica cl&#237;nica sobre el paciente con FA&#46; La mayor&#237;a de estas gu&#237;as realizan recomendaciones espec&#237;ficas sobre las caracter&#237;sticas cl&#237;nicas y el tratamiento en los pacientes ancianos&#46; En esta actualizaci&#243;n se revisan los comentarios espec&#237;ficos sobre las recomendaciones referentes al tratamiento antitromb&#243;tico en los pacientes ancianos con FA no valvular&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Su&#225;rez Fern&#225;ndez C&#44; Camafort M&#44; Cepeda Rodrigo JM&#44; D&#237;ez-Manglano J&#44; Formiga F&#44; Pose Reino A&#44; et al&#46; Tratamiento antitromb&#243;tico en el paciente anciano con fibrilaci&#243;n auricular&#46; Rev Clin Esp&#46; 2015&#59;215&#58;171&#8211;181&#46;</p>"
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviation</span>&#58; AF&#44; atrial fibrillation&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Adapted from&#58; Lubitz et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">1</span></a> Go et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">2</span></a> Heeringa et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">3</span></a> Barrios et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">4</span></a> G&#243;mez-Doblas et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">5</span></a> Baena-D&#237;ez et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">6</span></a> L&#243;pez Soto et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">7</span></a> Rodr&#237;guez-Ma&#241;ero et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">8</span></a> Barrios et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">9</span></a> Freedman et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">10</span></a> M&#233;rida-Rodrigo et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">11</span></a> Hanon et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">12</span></a> R&#248;nning et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">16</span></a> Camm et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">17</span></a> Camm et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">18</span></a> Pisters et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">19</span></a> Lip et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">20</span></a> Mant et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">26</span></a> Lip and Lane&#44;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">27</span></a> Siu and Tse&#44;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">28</span></a> Formiga et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">30</span></a> Gage et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">31</span></a> Gao et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">32</span></a> Darnell et al&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">33</span></a> and Fuenzalida et al&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">34</span></a></p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">The prevalence and incidence of AF increase with age&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Stroke associated with AF&#44; when compared with stroke unrelated to AF&#44; has increased mortality and morbidity and more sequela&#44; especially in the elderly&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Elderly patients with AF have a higher number of hospitalizations&#44; increased mortality and generate a greater degree of dependence when compared with younger patients&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Elderly patients have a considerable number of comorbidities&#44; which frequently results in polymedication&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">They also have other physical and mental disorders&#44; especially cognitive and mood disorders&#44; risk of falls&#44; malnutrition and social dependence&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">They are frequently underdiagnosed&#44; given that AF often progresses in the elderly asymptomatically or with few symptoms&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Advanced age is an independent predictor of stroke and mortality after stroke&#44; as well as a risk of bleeding&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Except where contraindicated&#44; elderly patients with AF should undergo anticoagulation&#46; However&#44; many are not due to the fear of bleeding&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab725463.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Peculiarities of atrial fibrillation in the elderly patient&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; NVAF&#44; nonvalvular atrial fibrillation&#59; CrCl&#44; creatinine clearance&#59; ITT&#44; intention to treat&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Adapted from Eikelboom et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">37</span></a> Halperin et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">39</span></a> Halvorsen et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">40</span></a> and Giugliano et al&#46;<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">42</span></a></p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Population&#47;comparator groups&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Results&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">RE-LY&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#44;113 patients &#40;mean age&#44; 71&#46;5 years&#59; 40&#46;1&#37; &#8805;75<span class="elsevierStyleHsp" style=""></span>years&#59; mean CHADS<span class="elsevierStyleInf">2</span> score&#44; 2&#46;1&#41; with NVAF were randomized to dabigatran 110<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h&#44; dabigatran 150<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h or warfarin&#46; Mean follow-up&#44; 2&#46;0 years&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">When compared with warfarin&#44; both dabigatran dosages &#40;110<span class="elsevierStyleHsp" style=""></span>mg and 150<span class="elsevierStyleHsp" style=""></span>mg twice daily&#41; presented a lower risk of intracranial and extracranial bleeding in participants younger than 75 years&#46; For participants 75 years or older&#44; intracranial bleeding was less frequent but extracranial was the same or more frequent&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">ROCKET-AF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;264 patients with NVAF &#40;mean age&#44; 73 years&#59; 44&#37; &#8805;75 years&#59; mean CHADS<span class="elsevierStyleInf">2</span> score&#44; 3&#46;4&#41; were randomized to rivaroxaban &#40;20<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#59; 15<span class="elsevierStyleHsp" style=""></span>mg if CrCl &#60;50<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#41; in comparison with warfarin&#46; Mean follow-up of 707 days in the ITT analysis&#59; 590 days in the per-protocol analysis&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The elderly patients had a greater risk of stroke and major bleeding episodes when compared with the younger patients&#46;The efficacy &#40;risk of stroke and systemic embolism&#41; and safety &#40;risk of major bleeding episodes&#41; of rivaroxaban when compared with warfarin were consistent with the overall results of the study&#44; regardless of age&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">ARISTOTLE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#44;201 patients &#40;mean age&#44; 70 years&#59; 31&#37; &#8805;75 years&#59; 13&#37; &#8805;80 years&#59; mean CHADS<span class="elsevierStyleInf">2</span> score&#44; 2&#46;1&#41; with NVAF were randomized to apixaban 5<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h &#40;or 2&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h in case &#8805;2 of the following criteria were met&#58; age &#8805;80 years&#44; weight &#8804;60<span class="elsevierStyleHsp" style=""></span>kg&#44; or creatinine level &#8805;133<span class="elsevierStyleHsp" style=""></span>&#956;mol&#47;L&#41; or warfarin&#46; Mean follow-up&#44; 1&#46;8 years&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Apixaban was more effective in reducing the risk of stroke and mortality&#44; with fewer major bleeding episodes&#44; total bleeding episodes and intracranial bleeding episodes&#44; regardless of age&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">ENGAGE AF-TIMI 48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#44;105 patients &#40;mean age&#44; 72 years&#59; 40&#46;1&#37; &#8805;75 years&#59; mean CHADS<span class="elsevierStyleInf">2</span> score&#44; 2&#46;8&#41; with NVAF were randomized to edoxaban 30<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#44; edoxaban 60<span class="elsevierStyleHsp" style=""></span>mg&#47;day or warfarin&#46; Mean follow-up&#44; 2&#46;8 years&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Both edoxaban dosages &#40;30 and 60<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41; were noninferior to warfarin with respect to preventing stroke and systemic embolism but had fewer major bleeding episodes&#44; regardless of age&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab725464.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Results of the RE-LY&#44; ROCKET-AF&#44; ARISTOTLE and ENGAGE AF-TIMI 48 studies by age&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; CrCl&#44; creatinine clearance&#59; NVAF&#44; nonvalvular atrial fibrillation&#46;</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Adapted from&#58; European Medicines Agency &#40;EMA&#41;&#44; Pradaxa<span class="elsevierStyleSup">&#174;</span><a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">43</span></a>&#59; European Medicines Agency &#40;EMA&#41;&#44; Xarelto<span class="elsevierStyleSup">&#174;</span><a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">44</span></a>&#59; and European Medicines Agency &#40;EMA&#41;&#44; Eliquis<span class="elsevierStyleSup">&#174;</span><a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">45</span></a>&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Drug&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dosage adjustment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Dabigatran&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; <span class="elsevierStyleItalic">Based on age</span>&#58;<span class="elsevierStyleHsp" style=""></span>&#8226; 75 years&#58; 150<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h<span class="elsevierStyleHsp" style=""></span>&#8226; 75&#8211;80 years&#58; 150 or 110<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h&#44; depending on thrombotic&#47;hemorrhagic risk<span class="elsevierStyleHsp" style=""></span>&#8226; &#8805;80 years&#58; 110<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h&#8226; <span class="elsevierStyleItalic">Based on renal function&#58;</span>If CrCl &#8805;50<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#58; dosage adjustment not necessary&#46;<span class="elsevierStyleHsp" style=""></span>&#8226; If CrCl is 30&#8211;50<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#58; assess 150<span class="elsevierStyleHsp" style=""></span>mg or 110<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h&#44; depending on thrombotic&#47;hemorrhagic risk&#46;<span class="elsevierStyleHsp" style=""></span>&#8226; If CrCl &#60;30<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#58; contraindicated&#8226; <span class="elsevierStyleItalic">Concomitant use of verapamil&#58; 110</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mg&#47;12</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">h</span>&#8226; <span class="elsevierStyleItalic">Based on weight&#58; A dosage adjustment is not necessary&#44; although close follow-up is recommended for patients weighing &#60;50</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">kg</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Rivaroxaban&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; <span class="elsevierStyleItalic">Based on age&#58; No dosage adjustment required</span>&#8226; <span class="elsevierStyleItalic">Based on renal function&#58;</span><span class="elsevierStyleHsp" style=""></span>&#8226; If CrCl &#8805;50<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#58; recommended dosage is 20<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#46;<span class="elsevierStyleHsp" style=""></span>&#8226; If CrCl is 15&#8211;49<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#58; recommended dosage is 15<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#46;<span class="elsevierStyleHsp" style=""></span>&#8226; If CrCl &#60;15<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#58; not recommended&#46;&#8226; <span class="elsevierStyleItalic">Based on weight&#58; No dosage adjustment required</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Apixaban&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; <span class="elsevierStyleItalic">In general&#44; the recommended dosage is 5</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mg&#47;12</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">h&#46; The dosage should be reduced to 2&#46;5</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mg&#47;12</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">h for NVAF and &#8805;2 of the following criteria&#58; &#8805;80 years&#44; &#8804;60</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">kg or serum creatinine level &#8805;1&#46;5</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mg&#47;dL&#46;</span>&#8226; <span class="elsevierStyleItalic">Based on age&#58; No dosage adjustment required&#44; except for age &#8805;80 years&#44; weight &#8804;60</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">kg or creatinine level &#8805;1&#46;5</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mg&#47;dL&#46;</span>&#8226; <span class="elsevierStyleItalic">Based on renal function&#58;</span><span class="elsevierStyleHsp" style=""></span>&#8226; Dosage adjustments are not required for patients with mild to moderate renal failure&#46;<span class="elsevierStyleHsp" style=""></span>&#8226; If creatinine level is &#8805;1&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#58; recommended dosage is 5<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h&#44; except for patients &#8805;80 years or &#8804;60<span class="elsevierStyleHsp" style=""></span>kg for whom the dosage should be reduced to 2&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h&#46;<span class="elsevierStyleHsp" style=""></span>&#8226; If CrCl is 15&#8211;29<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#58; recommended dosage is 2&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h&#46;<span class="elsevierStyleHsp" style=""></span>&#8226; If CrCl is &#60;15<span class="elsevierStyleHsp" style=""></span>mL&#47;min or on dialysis&#58; not recommended&#46;&#8226; <span class="elsevierStyleItalic">Based on weight&#58; No dosage adjustment required&#44; except for age &#8805;80 years&#44; weight &#8804;60</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">kg or creatinine level &#8805;1&#46;5</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mg&#47;dL&#46;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab725462.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Dosage adjustment of dabigatran&#44; rivaroxaban and apixaban for patients with nonvalvular atrial fibrillation&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; ESC&#44; European Society of Cardiology&#59; NICE&#44; National Institute for Health and Care Excellence&#59; SEN&#44; Spanish Society of Neurology&#46;</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Adapted from Camm et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">17</span></a> Camm et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">18</span></a> EMA Pradaxa<span class="elsevierStyleSup">&#174;</span>&#44;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">43</span></a> EMA Xarelto<span class="elsevierStyleSup">&#174;</span>&#44;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">44</span></a> EMA Eliquis<span class="elsevierStyleSup">&#174;</span>&#44;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">45</span></a> Goldstein et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">46</span></a> Skanes et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">47</span></a> You et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">48</span></a> Heidbuchel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">49</span></a> and Fuentes et al&#46;<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">50</span></a></p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Guidelines &#40;year of publication&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Recommendations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">ESC &#40;2010&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Specific section dedicated to the elderly population&#46;Compared with younger patients&#44; the elderly&#58;Are frailer and have more comorbidities&#46;Permanent AF is more common than paroxysmal&#47;persistent AF&#46;Atypical symptoms are more common&#46;They have a greater likelihood of presenting adverse effects from the drugs&#46;They are frequently underdiagnosed&#46;In general&#44; a heart rate control strategy is preferred over a rhythm control strategy&#46;Given that patients older than 75 years with AF have a &#62;4&#37; annual risk of presenting thromboembolic complications&#44; anticoagulation is indicated unless the risk of bleeding is very high &#40;the benefit of antiplatelet therapy is very limited in this population&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">American Heart Association&#47;American Stroke Association &#40;2011&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">To prevent stroke in the elderly&#44; it is essential to control blood pressure &#40;mainly systolic&#41; and have appropriate antithrombotic treatment&#46;The effects of combining antiplatelet with anticoagulant treatment in this population have not been clearly established&#46;In most elderly patients with stable ischemic heart disease and AF&#44; anticoagulant treatment is sufficient&#46;The detection of brain microhemorrhages in MRI could be useful when assessing the safety of antithrombotic treatment in an elderly patient&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">ESC &#40;2012&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The guidelines continue to recommend the use of the CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc and HAS-BLED scales for the risk stratification of stroke and bleeding&#44; respectively&#46;The guidelines emphasize the scarce benefit of aspirin for these patients&#44; with a high risk of bleeding&#44; and that its use should be limited to those patients who reject any type of anticoagulation&#46;There is concern on how to adapt the results of clinical trials with direct oral anticoagulants to the more elderly population&#44; who have numerous comorbidities and are frequently polymedicated&#44; as well as the fact that individuals with severe renal failure were excluded from these studies&#46; This is particularly important with dabigatran&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Canadian Guidelines &#40;2012&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The guidelines recommend the use of the CHADS<span class="elsevierStyleInf">2</span> and CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc scales for the risk stratification of stroke and the HAS-BLED scale for assessing the risk of bleeding&#46;With regard to direct oral anticoagulants&#44; dosage reductions are recommended for patients older than 75 years&#44; especially for those older than 80 and especially with dabigatran&#46;All patients with AF undergoing treatment with anticoagulants should undergo periodic monitoring of their renal function at least once a year&#46; Patients with a glomerular filtration rate of 30&#8211;50<span class="elsevierStyleHsp" style=""></span>mL&#47;min need a closer monitoring of their renal function and might require anticoagulant dosage reductions in certain conditions&#46; This is especially important for patients older than 75 years&#44; in whom the risk of bleeding increases significantly&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">American College of Chest Physicians &#40;2012&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">There are no substantial differences by age&#46;The guidelines specify that the risk of stroke and bleeding increases with age&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">European Heart Rhythm Association &#40;2013&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Specific guidelines on direct oral anticoagulants for patients with NVAF&#46;The guidelines insist on the need to monitor renal function &#40;annually&#44; every 6 months and every 3 months for creatinine clearance levels &#8805;60&#44; 30&#8211;60 and &#60;30<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#44; respectively&#41;&#46; This is especially relevant in elderly patients &#40;older than 75 years&#41; or those who are taking dabigatran&#46;For patients with concomitant active cancer who need anticoagulation&#44; vitamin K antagonists or heparins are preferred over direct oral anticoagulants&#46;In the event that antiplatelet therapy is considered necessary in the first year after an acute ischemic episode&#44; the use of low doses of direct oral anticoagulants is considered safer&#44; especially for patients with HAS-BLED scores &#8805;3&#46; In this context&#44; vitamin K antagonists &#40;INR objective 2&#8211;2&#46;5&#41; might be preferable&#44; especially for very elderly populations and for those with renal failure&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">SEN &#40;2014&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The guidelines recommend anticoagulation for patients with NVAF and a high risk of stroke &#40;CHADS<span class="elsevierStyleInf">2</span> score &#8805;2 or CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc score &#8805;1&#41;&#46; Therefore&#44; all patients older than 75 years should undergo anticoagulation&#44; except where contraindicated&#46;Vitamin K antagonists and direct oral anticoagulants may be used&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">American College of Cardiology&#47;American Heart Association&#47;Heart Rhythm Society &#40;2014&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Specific section dedicated to the elderly population&#46;Elderly patients have a greater possibility of presenting other comorbidities&#44; which can influence the approach&#46;Given that AF symptoms in these patients are usually scarce&#44; a heart rate control strategy is usually selected&#46;The guidelines recommend the use of the CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc scale for the risk stratification of stroke in patients with NVAF&#44; recommending anticoagulation &#40;either with vitamin K antagonists or direct oral anticoagulants&#41; for patients with a CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc score &#8805;2&#46;Patients&#8217; renal function should be measured before starting treatment with direct oral anticoagulants&#44; as well as subsequently at least once a year&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">American Academy of Neurology &#40;2014&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">These guidelines recognize the benefit of anticoagulation in elderly patients &#40;older than 75 years&#41;&#46; However&#44; many physicians do not use them because they believe that there is a very high risk of bleeding&#46;Except where there is recent spontaneous bleeding or intracranial hemorrhage&#44; anticoagulation should be proposed for all elderly patients with NVAF&#44; including patients with mild dementia or occasional falls&#46;The benefit of anticoagulation in patients with moderate to severe dementia or with frequent falls is uncertain&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">NICE &#40;2014&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">In patients aged 75 years or older&#44; the prevalence of AF is high &#40;almost 15&#37;&#41;&#46;A heart rate control strategy is recommended over a rhythm control strategy&#46;The use of anticoagulation is recommended for patients with a CHA2DS2-VASc score &#8805;2&#46;For patients aged 75 years or older&#44; anticoagulation &#40;with apixaban&#44; dabigatran&#44; rivaroxaban or the vitamin K antagonists&#41; should be started&#44; except when the risk of bleeding is very high&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab725461.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Specific recommendations from the clinical practice guidelines on elderly patients with atrial fibrillation&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:54 [
            0 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Stroke prevention in atrial fibrillation in older adults&#58; existing knowledge gaps and areas for innovation&#58; a summary of an American Federation for Aging research seminar"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;A&#46; Lubitz"
                            1 => "K&#46;A&#46; Bauer"
                            2 => "E&#46;J&#46; Benjamin"
                            3 => "R&#46;W&#46; Besdine"
                            4 => "D&#46;E&#46; Forman"
                            5 => "M&#46;E&#46; Gurol"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jgs.12456"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Geriatr Soc"
                        "fecha" => "2013"
                        "volumen" => "61"
                        "paginaInicial" => "1798"
                        "paginaFinal" => "1803"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24083473"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of diagnosed atrial fibrillation in adults&#58; national implications for rhythm management and stroke prevention&#58; the AnTicoagulation and Risk Factors in Atrial Fibrillation &#40;ATRIA&#41; Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;S&#46; Go"
                            1 => "E&#46;M&#46; Hylek"
                            2 => "K&#46;A&#46; Phillips"
                            3 => "Y&#46; Chang"
                            4 => "L&#46;E&#46; Henault"
                            5 => "J&#46;V&#46; Selby"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Med Assoc"
                        "fecha" => "2001"
                        "volumen" => "285"
                        "paginaInicial" => "2370"
                        "paginaFinal" => "2375"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence&#44; incidence and lifetime risk of atrial fibrillation&#58; the Rotterdam study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Heeringa"
                            1 => "D&#46;A&#46;M&#46; Van der Kuip"
                            2 => "A&#46; Hofman"
                            3 => "J&#46;A&#46; Kors"
                            4 => "G&#46; Van Herpen"
                            5 => "B&#46; Stricker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehi825"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2006"
                        "volumen" => "27"
                        "paginaInicial" => "949"
                        "paginaFinal" => "953"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16527828"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pacientes con fibrilaci&#243;n auricular asistidos en consultas de atenci&#243;n primaria&#46; Estudio Val-FAAP"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "V&#46; Barrios"
                            1 => "A&#46; Calder&#243;n"
                            2 => "C&#46; Escobar"
                            3 => "M&#46; De la Figuera"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.recesp.2011.08.008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Cardiol"
                        "fecha" => "2012"
                        "volumen" => "65"
                        "paginaInicial" => "47"
                        "paginaFinal" => "53"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22054913"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalencia de fibrilaci&#243;n auricular en Espa&#241;a&#46; Resultados del estudio OFRECE"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;J&#46; G&#243;mez-Doblas"
                            1 => "J&#46; Mu&#241;iz"
                            2 => "J&#46;J&#46; Martin"
                            3 => "G&#46; Rodr&#237;guez-Roca"
                            4 => "J&#46;M&#46; Lobos"
                            5 => "P&#46; Awamleh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rec.2013.07.014"
                      "Revista" => array:7 [
                        "tituloSerie" => "Rev Esp Cardiol"
                        "fecha" => "2014"
                        "volumen" => "67"
                        "paginaInicial" => "259"
                        "paginaFinal" => "269"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24774588"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1058274613005533"
                          "estado" => "S300"
                          "issn" => "10582746"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalencia de fibrilaci&#243;n auricular y factores asociados en Espa&#241;a&#44; an&#225;lisis de seis estudios de base poblacional&#46; Estudio DARIOS"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "en representaci&#243;n del estudio DARIOS"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;M&#46; Baena-D&#237;ez"
                            1 => "M&#46; Grau"
                            2 => "R&#46; For&#233;s"
                            3 => "D&#46; Fern&#225;ndez-Berg&#233;s"
                            4 => "R&#46; Elosua"
                            5 => "M&#46; Sorribes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rce.2014.06.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Clin Esp"
                        "fecha" => "2014"
                        "volumen" => "214"
                        "paginaInicial" => "505"
                        "paginaFinal" => "512"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25087090"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalencia de la fibrilaci&#243;n auricular y factores relacionados en pacientes ancianos hospitalizados&#58; estudio ESFINGE"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "en representaci&#243;n de los investigadores del estudio ESFINGE"
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; L&#243;pez Soto"
                            1 => "F&#46; Formiga"
                            2 => "X&#46; Bosch"
                            3 => "J&#46; Garc&#237;a Alegr&#237;a"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;"
                        "fecha" => "2012"
                        "volumen" => "138"
                        "paginaInicial" => "231"
                        "paginaFinal" => "237"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Trends in clinical profile and medical treatments of atrial fibrillation patients over the last 10 years"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Rodr&#237;guez-Ma&#241;ero"
                            1 => "V&#46; Bertomeu-Gonz&#225;lez"
                            2 => "A&#46; Cordero"
                            3 => "J&#46; Moreno-Arribas"
                            4 => "P&#46; Maz&#243;n"
                            5 => "L&#46; F&#225;cila"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.repc.2012.06.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Port Cardiol"
                        "fecha" => "2013"
                        "volumen" => "32"
                        "paginaInicial" => "103"
                        "paginaFinal" => "109"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23337429"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Atrial fibrillation and coronary heart disease&#58; fatal attraction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "V&#46; Barrios"
                            1 => "C&#46; Escobar"
                            2 => "R&#46; Echarri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Atr Fibrillation"
                        "fecha" => "2009"
                        "volumen" => "1"
                        "paginaInicial" => "262"
                        "paginaFinal" => "269"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Atrial fibrillation and stroke prevention in aging patients&#58; what&#39;s good can be even better"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;E&#46; Freedman"
                            1 => "B&#46;J&#46; Gersh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.114.010873"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2014"
                        "volumen" => "130"
                        "paginaInicial" => "129"
                        "paginaFinal" => "131"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24895453"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Supervivencia a largo plazo del ictus isqu&#233;mico"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; M&#233;rida-Rodrigo"
                            1 => "F&#46; Poveda-G&#243;mez"
                            2 => "M&#46; Camafort-Babkowski"
                            3 => "F&#46; Rivas-Ruiz"
                            4 => "M&#46;D&#46; Mart&#237;n-Escalante"
                            5 => "R&#46; Quir&#243;s-L&#243;pez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rce.2011.12.019"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Clin Esp"
                        "fecha" => "2012"
                        "volumen" => "212"
                        "paginaInicial" => "223"
                        "paginaFinal" => "228"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22425144"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "French society of geriatrics and gerontology and the French society of cardiology&#46; Expert consensus of the French society of geriatrics and gerontology and the French society of cardiology on the management of atrial fibrillation in elderly people"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "O&#46; Hanon"
                            1 => "P&#46; Assayag"
                            2 => "J&#46; Belmin"
                            3 => "J&#46;P&#46; Collet"
                            4 => "J&#46;P&#46; Emeriau"
                            5 => "L&#46; Fauchier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1684/pnv.2013.0407"
                      "Revista" => array:6 [
                        "tituloSerie" => "Geriatr Psychol Neuropsychiatr Vieil"
                        "fecha" => "2013"
                        "volumen" => "11"
                        "paginaInicial" => "117"
                        "paginaFinal" => "143"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23803629"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The impact of age on the epidemiology of atrial fibrillation hospitalizations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Naderi"
                            1 => "Y&#46; Wang"
                            2 => "A&#46;L&#46; Miller"
                            3 => "F&#46; Rodriguez"
                            4 => "M&#46;K&#46; Chung"
                            5 => "M&#46;J&#46; Radford"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amjmed.2014.07.026"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Med"
                        "fecha" => "2014"
                        "volumen" => "127"
                        "paginaInicial" => "e1"
                        "paginaFinal" => "e7"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25195188"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Caracter&#237;sticas y costes de los pacientes ingresados por arritmias cardiacas en Espa&#241;a"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Montes-Santiago"
                            1 => "V&#46; Rodil"
                            2 => "F&#46; Formiga"
                            3 => "J&#46;M&#46; Cepeda"
                            4 => "A&#46; Urrutia"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rce.2013.02.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Clin Esp"
                        "fecha" => "2013"
                        "volumen" => "213"
                        "paginaInicial" => "235"
                        "paginaFinal" => "239"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23561445"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Atrial fibrillation and incidence of dementia&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46;S&#46; Kwok"
                            1 => "Y&#46;K&#46; Loke"
                            2 => "R&#46; Hale"
                            3 => "J&#46;F&#46; Potter"
                            4 => "P&#46;K&#46; Myint"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1212/WNL.0b013e31820f2e38"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurology"
                        "fecha" => "2011"
                        "volumen" => "76"
                        "paginaInicial" => "914"
                        "paginaFinal" => "922"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21383328"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictors of mortality following acute stroke&#58; a cohort study with 12 years of follow-up"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "O&#46;M&#46; R&#248;nning"
                            1 => "K&#46; Stavem"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jstrokecerebrovasdis.2010.09.012"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Stroke Cerebrovasc Dis"
                        "fecha" => "2012"
                        "volumen" => "21"
                        "paginaInicial" => "369"
                        "paginaFinal" => "372"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21075646"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines for the management of atrial fibrillation&#58; the Task Force for the Management of atrial fibrillation of the European Society of Cardiology &#40;ESC&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;J&#46; Camm"
                            1 => "P&#46; Kirchhof"
                            2 => "G&#46;Y&#46; Lip"
                            3 => "U&#46; Schotten"
                            4 => "I&#46; Savelieva"
                            5 => "S&#46; Ernst"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehq278"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2010"
                        "volumen" => "31"
                        "paginaInicial" => "2369"
                        "paginaFinal" => "2429"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20802247"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2012 focused update of the ESC Guidelines for the management of atrial fibrillation&#58; an update of the 2010 ESC Guidelines for the management of atrial fibrillation&#46; Developed with the special contribution of the European Heart Rhythm Association"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;J&#46; Camm"
                            1 => "G&#46;Y&#46; Lip"
                            2 => "R&#46; de Caterina"
                            3 => "I&#46; Savelieva"
                            4 => "D&#46; Atar"
                            5 => "S&#46;H&#46; Hohnloser"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehs253"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2012"
                        "volumen" => "33"
                        "paginaInicial" => "2719"
                        "paginaFinal" => "2747"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22922413"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A novel user-friendly score &#40;HAS-BLED&#41; to assess 1-year risk of major bleeding in patients with atrial fibrillation&#58; the Euro Heart Survey"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46; Pisters"
                            1 => "D&#46;A&#46; Lane"
                            2 => "R&#46; Nieuwlaat"
                            3 => "C&#46;B&#46; de Vos"
                            4 => "H&#46;J&#46; Crijns"
                            5 => "G&#46;Y&#46; Lip"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.10-0134"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2010"
                        "volumen" => "138"
                        "paginaInicial" => "1093"
                        "paginaFinal" => "1100"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20299623"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach&#58; the Euro Heart Survey on atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46;Y&#46; Lip"
                            1 => "R&#46; Nieuwlaat"
                            2 => "R&#46; Pisters"
                            3 => "D&#46;A&#46; Lane"
                            4 => "H&#46;J&#46; Crijns"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.09-1584"
                      "Revista" => array:7 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2010"
                        "volumen" => "137"
                        "paginaInicial" => "263"
                        "paginaFinal" => "272"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19762550"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1058274613003856"
                          "estado" => "S300"
                          "issn" => "10582746"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0375"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Atrial fibrillation in the elderly"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46; Nantsupawat"
                            1 => "K&#46; Nugent"
                            2 => "A&#46; Phrommintikul"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s40266-013-0094-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Drugs Aging"
                        "fecha" => "2013"
                        "volumen" => "30"
                        "paginaInicial" => "593"
                        "paginaFinal" => "601"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23709402"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0380"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Warfarin versus aspirin for prevention of cognitive decline in atrial fibrillation&#58; randomized controlled trial &#40;Birmingham atrial fibrillation treatment of the aged study&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Mavaddat"
                            1 => "A&#46; Roalfe"
                            2 => "K&#46; Fletcher"
                            3 => "G&#46;Y&#46; Lip"
                            4 => "F&#46;D&#46; Hobbs"
                            5 => "D&#46; Fitzmaurice"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/STROKEAHA.113.004009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Stroke"
                        "fecha" => "2014"
                        "volumen" => "45"
                        "paginaInicial" => "1381"
                        "paginaFinal" => "1386"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24692475"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0385"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Decisional algorithm to prescribe vitamin K antagonist in geriatric patients with atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;S&#46; Sibai"
                            1 => "F&#46; Bellarbre"
                            2 => "N&#46; Ghazali"
                            3 => "M&#46;L&#46; Bureau"
                            4 => "M&#46; Priner"
                            5 => "P&#46; Ingrand"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1684/pnv.2014.0458"
                      "Revista" => array:6 [
                        "tituloSerie" => "Geriatr Psychol Neuropsychiatr Vieil"
                        "fecha" => "2014"
                        "volumen" => "12"
                        "paginaInicial" => "20"
                        "paginaFinal" => "24"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24647235"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0390"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Meta-analysis&#58; antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46;G&#46; Hart"
                            1 => "L&#46;A&#46; Pearce"
                            2 => "M&#46;I&#46; Aguilar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "2007"
                        "volumen" => "146"
                        "paginaInicial" => "857"
                        "paginaFinal" => "867"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17577005"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0395"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Oral anticoagulants versus antiplatelet therapy for preventing stroke in patients with non-valvular atrial fibrillation and no history of stroke or transient ischemic attacks"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;I&#46; Aguilar"
                            1 => "R&#46; Hart"
                            2 => "L&#46;A&#46; Pearce"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/14651858.CD009601.pub2"
                      "Revista" => array:4 [
                        "tituloSerie" => "Cochrane Database Syst Rev"
                        "fecha" => "2007"
                        "volumen" => "3"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23543580"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0400"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation &#40;the Birmingham Atrial Fibrillation Treatment of the Aged Study&#44; BAFTA&#41;&#58; a randomised controlled trial"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Midland Research Practices Network &#40;MidReC&#41;"
                          "etal" => true
                          "autores" => array:7 [
                            0 => "J&#46; Mant"
                            1 => "F&#46;D&#46; Hobbs"
                            2 => "K&#46; Fletcher"
                            3 => "A&#46; Roalfe"
                            4 => "D&#46; Fitzmaurice"
                            5 => "G&#46;Y&#46; Lip"
                            6 => "BAFTA investigators"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(07)61233-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2007"
                        "volumen" => "370"
                        "paginaInicial" => "493"
                        "paginaFinal" => "503"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17693178"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0405"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Stroke prevention with oral anticoagulation therapy in patients with atrial fibrillation &#8211; focus on the elderly"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46;Y&#46; Lip"
                            1 => "D&#46;A&#46; Lane"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circ J"
                        "fecha" => "2013"
                        "volumen" => "77"
                        "paginaInicial" => "1380"
                        "paginaFinal" => "1388"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23657131"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0410"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Net clinical benefit of warfarin therapy in elderly Chinese patients with atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46;W&#46; Siu"
                            1 => "H&#46;F&#46; Tse"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCEP.113.000858"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circ Arrhythm Electrophysiol"
                        "fecha" => "2014"
                        "volumen" => "7"
                        "paginaInicial" => "300"
                        "paginaFinal" => "306"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24610776"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0415"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Should patient characteristics influence target anticoagulation intensity for stroke prevention in nonvalvular atrial fibrillation&#58; the ATRIA study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;E&#46; Singer"
                            1 => "Y&#46; Chang"
                            2 => "M&#46;C&#46; Fang"
                            3 => "L&#46;H&#46; Borowsky"
                            4 => "N&#46;K&#46; Pomernacki"
                            5 => "N&#46; Udaltsova"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCOUTCOMES.108.830232"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circ Cardiovasc Qual Outcomes"
                        "fecha" => "2009"
                        "volumen" => "2"
                        "paginaInicial" => "297"
                        "paginaFinal" => "304"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20031854"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0420"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bajo porcentaje de anticoagulaci&#243;n oral en nonagenarios con fibrilaci&#243;n auricular"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "F&#46; Formiga"
                            1 => "A&#46; Ferrer"
                            2 => "E&#46; Henr&#237;quez"
                            3 => "R&#46; Pujol"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Clin Esp"
                        "fecha" => "2006"
                        "volumen" => "206"
                        "paginaInicial" => "410"
                        "paginaFinal" => "411"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16863634"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0425"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adverse outcomes and predictors of underuse of antithrombotic therapy in medicare beneficiaries with chronic atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46;F&#46; Gage"
                            1 => "M&#46; Boechler"
                            2 => "A&#46;L&#46; Doggette"
                            3 => "G&#46; Fortune"
                            4 => "G&#46;C&#46; Flaker"
                            5 => "M&#46;W&#46; Rich"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Stroke"
                        "fecha" => "2000"
                        "volumen" => "31"
                        "paginaInicial" => "822"
                        "paginaFinal" => "827"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10753982"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0430"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Analysis of antithrombotic therapy in elderly patients with atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "W&#46;Q&#46; Gao"
                            1 => "Y&#46;T&#46; Guo"
                            2 => "J&#46;L&#46; Ma"
                            3 => "P&#46; Zhu"
                            4 => "Y&#46;T&#46; Wang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4238/2014.January.29.4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Genet Mol Res"
                        "fecha" => "2014"
                        "volumen" => "13"
                        "paginaInicial" => "736"
                        "paginaFinal" => "743"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24615038"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0435"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bleeding risk factors affecting warfarin therapy in the elderly with atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46;W&#46; Darnell"
                            1 => "S&#46;C&#46; Davis"
                            2 => "J&#46;J&#46; Whitcomb"
                            3 => "J&#46;A&#46; Manfredi"
                            4 => "B&#46;T&#46; McLaurin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/DCC.0000000000000022"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dimens Crit Care Nurs"
                        "fecha" => "2014"
                        "volumen" => "33"
                        "paginaInicial" => "57"
                        "paginaFinal" => "63"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24496251"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0440"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evoluci&#243;n temporal del tratamiento de los pacientes con fibrilaci&#243;n auricular en un &#225;rea sanitaria urbana"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "en nombre de la Unidad de Fibrilaci&#243;n Auricular del Hospital Cl&#237;nic de Barcelona &#40;UFA&#41;"
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46; Fuenzalida"
                            1 => "B&#46; Coll-Vinent"
                            2 => "M&#46; Navarro"
                            3 => "A&#46; Cervera"
                            4 => "M&#46; Camafort"
                            5 => "L&#46; Mont"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;"
                        "fecha" => "2014"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0445"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mortality after ground-level fall in the elderly patient taking oral anticoagulation for atrial fibrillation&#47;flutter&#58; a long-term analysis of risk versus benefit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "T&#46;S&#46; Inui"
                            1 => "R&#46; Parina"
                            2 => "D&#46;C&#46; Chang"
                            3 => "T&#46;S&#46; Inui"
                            4 => "R&#46; Coimbra"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/TA.0000000000000138"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma Acute Care Surg"
                        "fecha" => "2014"
                        "volumen" => "76"
                        "paginaInicial" => "642"
                        "paginaFinal" => "649"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24553530"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0450"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Systematic review and network meta-analysis comparing antithrombotic agents for the prevention of stroke and major bleeding in patients with atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Cameron"
                            1 => "D&#46; Coyle"
                            2 => "T&#46; Richter"
                            3 => "S&#46; Kelly"
                            4 => "K&#46; Gauthier"
                            5 => "S&#46; Steiner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmjopen-2013-004301"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMJ Open"
                        "fecha" => "2014"
                        "volumen" => "4"
                        "paginaInicial" => "e004301"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24889848"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0455"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk of bleeding with 2 doses of dabigatran compared with warfarin in older and younger patients with atrial fibrillation&#58; an analysis of the randomized evaluation of long-term anticoagulant therapy &#40;RE-LY&#41; trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;W&#46; Eikelboom"
                            1 => "L&#46; Wallentin"
                            2 => "S&#46;J&#46; Connolly"
                            3 => "M&#46; Ezekowitz"
                            4 => "J&#46;S&#46; Healey"
                            5 => "J&#46; Oldgren"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.110.004747"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2011"
                        "volumen" => "123"
                        "paginaInicial" => "2363"
                        "paginaFinal" => "2372"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21576658"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0460"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impaired renal function and bleeding in elderly treated with dabigatran"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E&#46; Berthelot"
                            1 => "C&#46; Lavenu-Bombled"
                            2 => "L&#46; Orostegui-Giron"
                            3 => "C&#46; Desconclois"
                            4 => "P&#46; Assayag"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MBC.0000000000000077"
                      "Revista" => array:6 [
                        "tituloSerie" => "Blood Coagul&#46; Fibrinolysis"
                        "fecha" => "2014"
                        "volumen" => "25"
                        "paginaInicial" => "618"
                        "paginaFinal" => "620"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24509332"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0465"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy and safety of rivaroxaban compared with warfarin among elderly patients with nonvalvular atrial fibrillation in the ROCKET AF trial"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "on behalf of the ROCKET AF Steering Committee and Investigators"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;L&#46; Halperin"
                            1 => "G&#46;J&#46; Hankey"
                            2 => "D&#46;M&#46; Wojdyla"
                            3 => "J&#46;P&#46; Piccini"
                            4 => "Y&#46; Lokhnygina"
                            5 => "M&#46;R&#46; Patel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.113.005008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2014"
                        "volumen" => "130"
                        "paginaInicial" => "138"
                        "paginaFinal" => "146"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24895454"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0470"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy and safety of apixaban compared with warfarin according to age for stroke prevention in atrial fibrillation&#58; observations from the ARISTOTLE trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Halvorsen"
                            1 => "D&#46; Atar"
                            2 => "H&#46; Yang"
                            3 => "R&#46; de Caterina"
                            4 => "C&#46; Erol"
                            5 => "D&#46; Garcia"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehu046"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2014"
                        "volumen" => "35"
                        "paginaInicial" => "1864"
                        "paginaFinal" => "1872"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24561548"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0475"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "New oral anticoagulants in elderly adults&#58; evidence from a meta-analysis of randomized trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46; Sardar"
                            1 => "S&#46; Chatterjee"
                            2 => "S&#46; Chaudhari"
                            3 => "G&#46;Y&#46; Lip"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jgs.12799"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Geriatr Soc"
                        "fecha" => "2014"
                        "volumen" => "62"
                        "paginaInicial" => "857"
                        "paginaFinal" => "864"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24786913"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0480"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Edoxaban versus warfarin in patients with atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "ENGAGE AF-TIMI 48 Investigators"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;P&#46; Giugliano"
                            1 => "C&#46;T&#46; Ruff"
                            2 => "E&#46; Braunwald"
                            3 => "S&#46;A&#46; Murphy"
                            4 => "S&#46;D&#46; Wiviott"
                            5 => "J&#46;L&#46; Halperin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1310907"
                      "Revista" => array:7 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2013"
                        "volumen" => "369"
                        "paginaInicial" => "2093"
                        "paginaFinal" => "2104"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24251359"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0749806307010420"
                          "estado" => "S300"
                          "issn" => "07498063"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib0485"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "European Medicines Agency &#40;EMA&#41;&#46; Pradaxa<span class="elsevierStyleSup">&#174;</span>&#46; Resumen de las caracter&#237;sticas del producto&#46; Available from&#58; <a href="http://www.ema.europa.eu/docs/es_ES/document_library/EPAR_-_Product_Information/human/000829/WC500041059.pdf">http&#58;&#47;&#47;www&#46;ema&#46;europa&#46;eu&#47;docs&#47;es&#95;ES&#47;document&#95;library&#47;EPAR&#95;-&#95;Product&#95;Information&#47;human&#47;000829&#47;WC500041059&#46;pdf</a> &#91;accessed 24&#46;10&#46;14&#93;"
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib0490"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "European Medicines Agency &#40;EMA&#41;&#46; Xarelto<span class="elsevierStyleSup">&#174;</span>&#46; Resumen de las caracter&#237;sticas del producto&#46; Available from&#58; <a href="http://www.ema.europa.eu/docs/es_ES/document_library/EPAR_-_Product_Information/human/000944/WC500057108.pdf">http&#58;&#47;&#47;www&#46;ema&#46;europa&#46;eu&#47;docs&#47;es&#95;ES&#47;document&#95;library&#47;EPAR&#95;-&#95;Product&#95;Information&#47;human&#47;000944&#47;WC500057108&#46;pdf</a> &#91;accessed 08&#46;10&#46;14&#93;"
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib0495"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "European Medicines Agency &#40;EMA&#41;&#46; Eliquis<span class="elsevierStyleSup">&#174;</span>&#46; Resumen de las caracter&#237;sticas del producto&#46; Available from&#58; <a href="http://www.ema.europa.eu/docs/es_ES/document_library/EPAR_-_Product_Information/human/002148/WC500107728.pdf">http&#58;&#47;&#47;www&#46;ema&#46;europa&#46;eu&#47;docs&#47;es&#95;ES&#47;document&#95;library&#47;EPAR&#95;-&#95;Product&#95;Information&#47;human&#47;002148&#47;WC500107728&#46;pdf</a> &#91;accessed 29&#46;09&#46;14&#93;"
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib0500"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines for the primary prevention of stroke&#58; a guideline for healthcare professionals from the American Heart Association&#47;American Stroke Association"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46;B&#46; Goldstein"
                            1 => "C&#46;D&#46; Bushnell"
                            2 => "R&#46;J&#46; Adams"
                            3 => "L&#46;J&#46; Appel"
                            4 => "L&#46;T&#46; Braun"
                            5 => "S&#46; Chaturvedi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/STR.0b013e3181fcb238"
                      "Revista" => array:6 [
                        "tituloSerie" => "Stroke"
                        "fecha" => "2011"
                        "volumen" => "42"
                        "paginaInicial" => "517"
                        "paginaFinal" => "584"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21127304"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib0505"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Focused 2012 update of the Canadian Cardiovascular Society atrial fibrillation guidelines&#58; recommendations for stroke prevention and rate&#47;rhythm control"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;C&#46; Skanes"
                            1 => "J&#46;S&#46; Healey"
                            2 => "J&#46;A&#46; Cairns"
                            3 => "P&#46; Dorian"
                            4 => "A&#46;M&#46; Gillis"
                            5 => "M&#46;S&#46; McMurtry"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.cjca.2012.01.021"
                      "Revista" => array:6 [
                        "tituloSerie" => "Can J Cardiol"
                        "fecha" => "2012"
                        "volumen" => "28"
                        "paginaInicial" => "125"
                        "paginaFinal" => "136"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22433576"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib0510"
              "etiqueta" => "48"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antithrombotic therapy for atrial fibrillation&#58; antithrombotic therapy and prevention of thrombosis&#44; 9th ed&#58; American College of Chest Physicians Evidence-Based Clinical Practice Guidelines"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;J&#46; You"
                            1 => "D&#46;E&#46; Singer"
                            2 => "P&#46;A&#46; Howard"
                            3 => "D&#46;A&#46; Lane"
                            4 => "M&#46;H&#46; Eckman"
                            5 => "M&#46;C&#46; Fang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.11-3192"
                      "Revista" => array:5 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2012"
                        "volumen" => "141"
                        "numero" => "2 Suppl&#46;"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22396557"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib0515"
              "etiqueta" => "49"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46; Heidbuchel"
                            1 => "P&#46; Verhamme"
                            2 => "M&#46; Alings"
                            3 => "M&#46; Antz"
                            4 => "W&#46; Hacke"
                            5 => "J&#46; Oldgren"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/europace/eut083"
                      "Revista" => array:7 [
                        "tituloSerie" => "Europace"
                        "fecha" => "2013"
                        "volumen" => "15"
                        "paginaInicial" => "625"
                        "paginaFinal" => "651"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23625942"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1058274610003836"
                          "estado" => "S300"
                          "issn" => "10582746"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            49 => array:3 [
              "identificador" => "bib0520"
              "etiqueta" => "50"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gu&#237;a para el tratamiento preventivo del ictus isqu&#233;mico y AIT &#40;II&#41;&#46; Recomendaciones seg&#250;n subtipo etiol&#243;gico"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; Fuentes"
                            1 => "J&#46; G&#225;llego"
                            2 => "A&#46; Gil-Nu&#241;ez"
                            3 => "A&#46; Morales"
                            4 => "F&#46; Purroy"
                            5 => "J&#46; Roquer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.nrl.2011.06.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurologia"
                        "fecha" => "2014"
                        "volumen" => "29"
                        "paginaInicial" => "168"
                        "paginaFinal" => "183"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21937151"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            50 => array:3 [
              "identificador" => "bib0525"
              "etiqueta" => "51"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;T&#46; January"
                            1 => "L&#46;S&#46; Wann"
                            2 => "J&#46;S&#46; Alpert"
                            3 => "H&#46; Calkins"
                            4 => "J&#46;C&#46; Cleveland Jr&#46;"
                            5 => "J&#46;E&#46; Cigarroa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2014"
                        "paginaInicial" => "2071"
                        "paginaFinal" => "2104"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            51 => array:3 [
              "identificador" => "bib0530"
              "etiqueta" => "52"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Summary of evidence-based guideline update&#58; prevention of stroke in nonvalvular atrial fibrillation&#58; report of the Guideline Development Subcommittee of the American Academy of Neurology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Culebras"
                            1 => "S&#46;R&#46; Mess&#233;"
                            2 => "S&#46; Chaturvedi"
                            3 => "C&#46;S&#46; Kase"
                            4 => "G&#46; Gronseth"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1212/WNL.0000000000000145"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurology"
                        "fecha" => "2014"
                        "volumen" => "82"
                        "paginaInicial" => "716"
                        "paginaFinal" => "724"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24566225"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            52 => array:3 [
              "identificador" => "bib0535"
              "etiqueta" => "53"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Atrial fibrillation&#58; the management of atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "National Institute for Health and Clinical Excellence &#40;NICE&#41;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2014&#44; June"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            53 => array:3 [
              "identificador" => "bib0540"
              "etiqueta" => "54"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Situaci&#243;n del tratamiento anticoagulante oral en pacientes con fibrilaci&#243;n auricular no valvular en Espa&#241;a&#46; Estudio REACT-AF"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "F&#46; De Andr&#233;s-Nogales"
                            1 => "I&#46; Oyag&#252;ez"
                            2 => "L&#46; Beteg&#243;n-Nicol&#225;s"
                            3 => "C&#46; Canal-Fontcuberta"
                            4 => "J&#46; Soto-&#193;lvarez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Rev Clin Esp"
                        "fecha" => "2015"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/22548874/0000021500000003/v1_201504010033/S2254887415000144/v1_201504010033/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "1904"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Clinical Up-Date"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/22548874/0000021500000003/v1_201504010033/S2254887415000144/v1_201504010033/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887415000144?idApp=WRCEE"
]
Article information
ISSN: 22548874
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2023 March 5 4 9
2018 February 17 0 17
2018 January 8 0 8
2017 December 9 0 9
2017 November 15 0 15
2017 October 9 0 9
2017 September 13 0 13
2017 August 2 0 2
2017 July 11 0 11
2017 June 9 0 9
2017 May 9 0 9
2017 April 6 0 6
2015 October 0 1 1
2015 April 0 3 3
2015 February 0 2 2
Show all

Follow this link to access the full text of the article

Idiomas
Revista Clínica Española (English Edition)
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?