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"textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Atrial fibrillation (AF) is a highly prevalent disease and is closely related to thrombotic events. International guidelines therefore firmly recommend anticoagulant therapy with vitamin K antagonists (VKAs) or direct oral anticoagulants (DOAs).<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The health-related quality of life has been widely studied in patients treated with VKAs, but there have been few studies on patients treated with DOAs. The health-related quality of life has been assessed using various generic and specific quality-of-life tests.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">2,3</span></a> The information provided suggests that these patients quality of life is related to the frequent monitoring visits and dietary restrictions (for VKAs) and hemorrhagic complications and limited physical activity (for both treatments).</p><p id="par0015" class="elsevierStylePara elsevierViewall">Anticoagulant therapy compliance is a highly relevant aspect, considering the risk that the incorrect taking of medication entails.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a> Numerous studies have evaluated VKA treatment compliance; however, our understanding of compliance with DOAs is highly limited, with more than a quarter of patients presenting suboptimal compliance.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a> In terms of patient satisfaction, the results so far are conflicting, showing dissatisfaction due to problems of anxiety and depression.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a> In other cases the results show a lower burden and greater perceived benefit.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In this issue, the results of an interesting article by Barrios et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> are presented. The authors compared the quality of life, treatment compliance and satisfaction between patients with anticoagulated AF taking VKA or dabigatran, which was the first DOA introduced into clinical practice.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a> The authors included more than 1000 patients treated in outpatient cardiology clinics. Quality of life was assessed using the AF-QoL test, which has been validated in Spain for this disease.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">10</span></a> The results showed that the patients treated with dabigatran had a better quality-of-life score at 6 months of follow-up, results that differed from the reference clinical trial on dabigatran (RELY) that observed no differences in quality of life between the two treatment groups at 1 year of follow-up.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">11</span></a> The benefit of dabigatran observed in this new study could be an accurate reflection of clinical practice, where the follow-up conditions are significantly different from those of a clinical trial.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Moreover, the article by Barrios et al. also analyzed the degree of compliance with these 2 groups of anticoagulants. It is important to note that compliance with dabigatran was very high during the 6 months of follow-up (approximately 90%), which was significantly greater than that of VKA (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.001). The authors note, however, that the follow-up period might have been too short and that the results might have been lower if the follow-up had been extended a year or more.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The study's most controversial issue is the assessment of the study patients’ degree of satisfaction. While most studies have estimated this parameter with a test that assesses the degree of patient wellbeing,<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a> the present study measured it indirectly, using a survey directed at the physicians responsible for the patients. The survey was developed <span class="elsevierStyleItalic">ad hoc</span> for this study, which collected the physician's perception of the patients’ satisfaction with the treatment.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Despite these limitations, the study by Barrios et al. throws light on additional important aspects that have seldom been studied on anticoagulant therapy in patients with AF, such as quality of life and treatment compliance. The information provided by this study is a further test of the superiority of DOAs over VKA in cases of nonvalvular AF. We congratulate the authors for their contribution. Nevertheless, these results should be corroborated in future studies.</p></span>"
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