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

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 fbrillation (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 signifcant 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 signifcantly 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 fbrillation, hemorrhage, risk, stroke, therapeutics