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Thromboembolic and hemorrhagic risk stratification in patients with atrial fibrillation. Part II: hemorrhagic risk and guidelines recommendations

机译:心房颤动患者血栓栓塞和出血性风险分层。第二部分:出血风险和指导方面的建议

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摘要

Robust evidence exists on the efficacy of traditional anticoagulant oral therapy in the prevention of thrombo-embolic risk in patients with non valvular atrial fibrillation, but fears and concerns of hemorrhagic events for the physicians and logistic difficulties related to the periodic International Normalized Ratio evaluation for the patients are at the basis of a noticeable under-utilization of the therapy with vitamin K antagonists in the real world. Stratification of the hemorrhagic risk has, thus, particular importance; for this objective we may use now several score system, among whom the more suggested is the HASBLED, with the principal aim to select and trait modifiable risk factors for bleeding. These score systems have been evaluated in some recent clinical trials. During the last years, a number of national and international guidelines on the prevention of the thrombo-embolic risk in patients with non valvular atrial fibrillation have been updated. These guidelines, generally, recommend the use of the CHA2DS2VaSC score for the evaluation of the thrombo-embolick risk, and of the HAS-BLED score for the evaluation of the hemorrhagic one. The consequent risk stratification is fundamental as a clinical guide for the use of oral anticoagulant therapy.
机译:有稳健的证据存在于传统抗凝血口腔治疗在预防非瓣膜心房颤动患者血栓栓塞风险中的效果,但恐惧和担心医生的出血事件和与定期国际标准化比率评估相关的后勤困难患者是在现实世界中与维生素K拮抗剂的治疗的显着不足的基础。因此,出血风险的分层特别重要;为此目的,我们现在可以使用几个得分系统,其中建议的越来越多的人,主体旨在选择和性状的可改性风险因素进行出血。这些分数系统已在最近的一些临床试验中进行评估。在过去几年中,已经更新了一些关于预防非瓣膜心房颤动患者血栓栓塞风险的国家和国际指南。这些准则通常建议使用CHA2DS2VASC评分来评估血栓栓塞风险,以及对出血性的评估的具有BLDED分数。随后的风险分层是使用口服抗凝治疗的临床指南的基础。

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