What measures should be taken to reduce the risk of stroke and bleeding on antithrombotic therapy?
Good control of BP is vital to reduce the risk of stroke and is essential to decrease the risk of bleeding on antithrombotic therapy. Adherence to current guidelines on the management of hypertension should be followed. Among patients receiving VKA, maintenance of an international normalized ratio (INR) in the therapeutic range (2.0-3.0) is essential. The proportion of time spent in this range (TTR) should be at least 65% but the ultimate aim/target should be 100%. INR control can potentially be improved by more frequent monitoring and review of factors influencing INR control (diet-, alcohol-, and drug-interactions). There is evidence that improving patient education about INR control, INR management by dedicated anticoagulation clinics with experienced personnel, and self-monitoring/self-management in selected can increase TTR. Increasing patient's awareness of the importance of OAC medication adherence and the potential bleeding risks associated with overdose are also essential to minimize bleeding complications. 