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Int J Prev Med. 2019 May 17;10:85. doi: 10.4103/ijpvm.IJPVM_426_18. eCollection 2019.

Optimal Choice of Pharmacological Therapy - Prevention of Stroke and Assessment of Bleeding Risk in Patients with Atrial Fibrillation.

Author information

1
Clinic for Heart, Blood Vessel and Rheumatic Diseases, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
2
Department of Pharmacology, Sarajevo Medical School, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina.
3
Department of Cardiology, General Hospital "Prim.dr.Abdulah Nakas", Sarajevo, Bosnia and Herzegovina.
4
Zentrum für Anästhesie, Intensivmedizin, Notfallmedizin und Schmerztherapie, SLK Kliniken Heilbronn, Heilbronn, Germany.
5
Department of Pediatric Cardiology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
6
Department of Science Editing, Academy of Medical Sciences in Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina.

Abstract

Background:

The aim of the study was to highlight the importance of adequate anticoagulant therapy and the correlation of higher risk of stroke.

Methods:

This study analyzed data obtained from 103 patients with diagnosis of atrial fibrillation (AF) (39 of them had a stroke). Patients were divided into groups according to the CHADS2, CHA2DS2-VASc, and HASBLED scores.

Results:

An analysis showed that anticoagulant drugs were more often prescribed to subjects <75 years of age (P = 0.001). Patients with a higher CHADS2 score had a higher CHA2DS2-VASc score and vice versa (rho = 0.513; P = 0.0001). According to the CHA2DS2-VASc, 91.3% of the patients examined were prescribed an anticoagulant medication as a therapy at discharge from the hospital. The result was statistically significant compared to the practice where an anticoagulant was prescribed to 55.9% of high-risk subjects as estimated by the CHA2DS2-VASc score (P < 0.05). Our results also show that rivaroxaban is more commonly prescribed as a discharge therapy than warfarin (χ2 = 12.401; P = 0.0001). Furthermore, a significantly higher number of patients who were being prescribed aspirin (38.5%) had a stroke compared to 12.8% of patients who were being prescribed warfarin (χ2 = 12.259; P = 0.0001).

Conclusions:

Novel oral anticoagulants (NOACs) seem to be a better choice as a pharmacological therapy in the treatment of AF, due to a lack of adequate monitoring of patients' international normalized ratio (INR) values. CHA2DS2-VASc and HASBLED scores must be used as a part of routine clinical diagnostics when dealing with patients with AF.

KEYWORDS:

Atrial fibrillation; hemorrhage; risk; stroke; therapeutics

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