In Mexico, it is estimated that atrial fibrillation (AF) affects 426,025 people aged >60 years. Cerebrovascular disease is the third leading cause of death in the country, with 31,999 deaths in 2013; about 5333 of those can be attributed to AF-associated stroke. The direct cost of managing AF would be the equivalent of between US$0.7 and 1.89 billion a year. About 66,460 Mexicans with undetected AF could be receiving prevention therapy. If all people with AF were managed using oral anticoagulants, the number of preventable strokes would be approximately 1993, and this would provide potential cost offsets.

Direct oral anticoagulants (apixaban, dabigatran and rivaroxaban) have been widely used in Mexico since 2008 (since 2011, for stroke prophylaxis in patients with AF) and have demonstrated at least comparable effectiveness to that of vitamin K antagonists, with superior safety and simpler management. These agents may represent an opportunity for long-term management to be undertaken in anticoagulation clinics in the first level of health care, by trained primary care physicians, once the drug is prescribed by the specialist.