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Background/Aim. Despite the introduction of new oral anticoagulants (dabigatran, rivoroxaban, apixaban), vitamin K antagonists (VKA), such as warfarin and acenocoumarol are still the most widely used oral anticoagulants for the treatment of nonvalvular atrial fibrillation (NVAF). The time in therapeutic range (TTR) represents a measure of the quality of the anticoagulant effect of these drugs, and it is considered that the lower value of TTR is associated with the adverse effects of therapy. The aim of this study was to evaluate of the effectiveness of VKA therapy in patients with NVAF and to identify factors affecting the anticoagulation efficacy. Methods. A retrospective study was conducted on a population of 725 outpatients with NVAF, treated with VKA and followed in the Blood Transfusion Institute of Niš, Serbia, from January to December 2017. Laboratory control of the INR was done from capillary blood of patients on Thrombotrack Solo (Axis Shield, Norway) and Thrombostat (Behnk Elektronik, Germany). Targeted therapeutic INR was between 2.0 and 3.0. For each patient all available INR values were evaluated to calculate the individual TTR according to the Rosendaal method. Results. The study included a total of 725 patients with NVAF which had 6,105 INR measurements, what was 8.13 ± 2.47 INR measurements per patient. The mean value of TTR and was 60.15 ± 17.52%, but 49.72% of patients had TTR less than 60%. Patients were at high risk of thrombosis in 6.15% of time (INR < 1.5) and high risk of bleeding in 2.2% of time (INR > 4.5). The most significant independent factors affecting the quality of VKA therapy were gender, arterial hypertension, diabetes mellitus and the use of amiodarone and antiplatelet drugs (aspirin, clopidogrel). Conclusion. The TTR is undoubtedly useful indicator of the VKA treatment effectiveness. The most important predictors of poorer efficacy of VKA therapy are: arterial hypertension, diabetes mellitus, patients' gender and the use of amiodarone and antiplatelet drugs (aspirin, clopidogrel). To improve the quality of VKA therapy, education of patients and better collaboration with them, as well as a successful teamwork of clinicians are also imperative.

Introduction. Bleeding scoring systems are used for predicting the risk of a specific primary outcome in a specific population.In this article, we present scoring systems frequently used in internist practice. Bleeding scoring systems for acute upper gastrointestinal bleeding. Are divided into clinical, endoscopic,and combined scoring systems, according to the type of variables included. Besides traditional systems (Rockall, Glasgow-Blatchford), we primarily present clinical scoring systems used for upper gastrointestinal bleeding. Bleeding scoring systems for patients with atrial fibrillation on anticoagulant therapy. We refer to the most significant scoring systems - ATRIA, HAS-BLED, and ORBIT. Since the prognostic performance of the existing scoring systems is less than satisfactory, medical organizations suggest they should be used for recognizing patients who deserve close monitoring during anticoagulant therapy. Bleeding scoring systems for patients with acute myocardial infarction treated with percutaneous coronary intervention. ACUITY-HORIZONS was proven to be superior to other scoring systems in predicting bleeding within 30 days in patients with a myocardial infarction treated with transradial percutaneous coronary intervention. Bleeding scoring systems for bleeding disorders. Scoring systems enable the detection of bleeding disorders before performing laboratory tests. Considering the frequency severity of symptoms, newer systems have been developed for the pediatric population and self-testing by modifying the original scoring system. Conclusion. Although medical organizations encourage the implementation of scoring systems in clinical practice, the development of newer and enhanced existing systems requires a comprehensive approach and critical analysis of the existing systems. [ABSTRACT FROM AUTHOR]

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