Stirbys Petras
The Department of Cardiology, Hospital of Lithuanian University of Health Sciences , Kaunas Clinic, Kaunas, Lithuania.
J Atr Fibrillation. 2016 Aug 31;9(2):1432. doi: 10.4022/jafib.1432. eCollection 2016 Aug-Sep.
Atrial fibrillation is the most prevalent cardiac arrhythmia with a high risk of ischemic stroke. Thromboprophylaxis plays a key role in prevention of cardioembolic and non-cardioembolic events. Oral antithrombotic drugs are most often used to reduce hypercoagulable state. Patients may suffer from both under- and overtreatment compromising the outcomes. Medication peculiarities at large are well-known and widely debated. Non-adherence to antithrombotic drug regimen poses a significant risk of stroke. There is a pressing need for more detailed delineation of risk factors, namely by incorporation of the letter "N" (meaning "Non-adherence to drug therapy") into the well-known risk score alphanumeric display: CHADSN-VASc. Better delineation of risk factors related to antithrombotic treatment as well as those related to treatment for congestive heart failure, hypertension, diabetes are desirable. Similarly, the bleeding risk score formula HAS-BLED might be improved by an additional risk factor, marked as the symbol "E", meaning "Excessive antithrombotic dosing" i.e. HAS-BLEDE. Improved formulas would help raise the predictive scores value and awareness for clinicians facing the problem of non-adherence to treatment regimen. If patients properly followed the prescribed drug therapy regimen it would potentially reveal that we already have ideal or near ideal antithrombotic drug(s). These drugs, herein non-specified, are widely used, but due to non-adherence they are not categorized as the best ones. That is why considerable efforts are focused on continued research and new developments.
心房颤动是最常见的心律失常，具有较高的缺血性卒中风险。血栓预防在预防心源性和非心源性栓塞事件中起关键作用。口服抗血栓药物最常用于降低高凝状态。患者可能因治疗不足和过度治疗而影响治疗效果。药物治疗的特殊性是众所周知且广泛存在争议的。不坚持抗血栓药物治疗方案会带来显著的卒中风险。迫切需要更详细地描述风险因素，即将字母“N”（表示“不坚持药物治疗”）纳入著名的风险评分字母数字显示：CHADSN-VASc。更好地描述与抗血栓治疗相关的风险因素以及与充血性心力衰竭、高血压、糖尿病治疗相关的风险因素是很有必要的。同样，出血风险评分公式HAS-BLED可能通过一个额外的风险因素得到改进，该因素标记为符号“E”，表示“抗血栓药物过量使用”，即HAS-BLEDE。改进后的公式将有助于提高预测评分值，并提高临床医生对不坚持治疗方案问题的认识。如果患者正确遵循规定的药物治疗方案，可能会发现我们已经有了理想或接近理想的抗血栓药物。这些未具体指明的药物被广泛使用，但由于不坚持治疗，它们未被归类为最佳药物。这就是为什么大量努力都集中在持续研究和新进展上。
