[Non-valvular atrial fibrillation and cerebral infarction]

Non-valvular auricular fibrillation (NVAF) is linked to a high rate of cerebral embolism (CE), being one of the main causes of cerebral infarction in elderly people. The real risk of these patients suffering a cerebral embolism depends on various factors such as the type of fibrillation (chronic as opposed to paroxistic) and on the coexistence or not of other cerebrovascular risk factors. In recent years five random essays have been published on the primary prophylaxis of CE in patients with NVAF (AFASAK, SPAF, BAATAF, CAFA and SPINAF) and one on its secondary prophylaxis (EAFT), which have evaluated the efficiency of oral anticoagulation, acetilsalicilic acid with placebo. The results indicate that oral anticoagulation is efficient and safe both in primary and secondary prophylaxis. Use of acetilsalicilic acid is safe, but less efficient, although it is easier to administer and more economical, and would be indicated for patients with a contraindication for anticoagulation or who are not compliant to therapy. Currently we need to determine which factors identify the patient subgroups with high risk NVAF both as regards the appearance of CE and that of haemorrhagic complications for anticoagulation. The identification of these subgroups would probably make it possible to give a more exact profile of the right treatment for these patients.