Anticoagulant therapy in patients with nonvalvular atrial fibrillation in real clinical practice: the problem of therapy safety and treatment adherence

Abstract

Atrial fibrillation (AF) is the most common arrhythmia in the adult population, and the number of patients with this arrhythmia will increase in the future. As a result, the number of patients taking anticoagulants (ACs), which are considered "high alert medication" is constantly increasing. 
 The aim. To highlight the problems of ACs use in patients with non-valvular AF in real clinical practice, to consider the therapy safety and treatment adherence. 
 The main body. Approval of new oral ACs has provided more options to clinicians and patients, but even with their use, errors are possible that increase the risk of bleeding. Mistakes can be made by both patients and doctors. The introduction of training as a mandatory element in the complex therapy of AF helps to reduce the number of errors that the patient could make. The clinical condition, the availability of monitoring and the patient's wishes for treatment may change over time, and this may lead to the need to switch the AC, which is potentially dangerous in terms of side effects. The risk of bleeding increases regardless of the direction of change of AC - the very fact of transition is important. Doctor`s errors play a significant role in the risk increase at this stage, and it is important to raise their awareness of the rules for the ACs switch to avoid bleeding. The article presents the rules of transition from one oral AC to another, following which doctors will minimize the risk of side effects in clinical practice.
 Conclusion. The use of AC for patients with AF is life-saving, but if used improperly, life-threatening side effects can occur. According to research, in many cases, the development of the latter could be prevented primarily through patient education and the proper doctor training.