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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.

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



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


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.


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).


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.


Atrial fibrillation; hemorrhage; risk; stroke; therapeutics

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