Current Application Status Of Anticoagulation Therapy In Hospitalized Patients With Non-valvular Atrial Fibrillation:a Single-Center, Retrospective, Observational Study

Objective:1.To study the clinical characters and causes in patients with non-valvular atrial fibrillation(NVAF).2. To evaluate the stroke and bleeding risk of patients and analyze the current application status of the anticoagulant therapy in patients with NVAR To analyze the statistical differences between warfarin and dabigatran within each group and the efficient of warfarin.3.To explore the possible factors that can affect the selection of antithrombotic schemes and anticoagulants.Methods:1. To collect the clinical information and analyze the clinical characters of inpatients diagnosed with NVAF in Qi Lu hospital of Shan Dong university between 2010.1 and 2015.6 through Lianzhou digital medical record retrieval system.2.Patients were categoried by CHA2DS2-VASc Score and HAS-BLED Score. To analyze the current application status of the anticoagulant therapy in different groups which were divided by the type of atrial fibrillation, stroke and bleeding risk. To analyze the statistical differences between warfarin and dabigatran within each group. To analyze the international normalized ratio (INR) among the patients with NVAF who used warfarin.3.Single factor variance analysis and multi-factors logistic regression analysis were used to investigate the possible factors that can influence the selection of antithrombotic scheme and anticoagulants.Result:1.839 patients with NVAF were included in our study.341 (40.6%) cases were Female patients. Patients with paroxysmal atrial fibrillation, persistent atrial fibrillation, long persistent atrial fibrillation and permanent fibrillation were 504(60. 1%)cases, 114(13.6%)cases,210(25.0%)cases,11(1.3%)cases respectively. The factors of age(>65 years), coronary heart disease, hypertension, diabetes, stroke are the main risk factors of NVAF. According to the CHA2DS2-VASC score,56 cases(6.7%) of patients with NVAF were defined as low stroke risk(score=0), 114cases(13.6%) as intermediate stroke risk (score=1), and 669 cases (79.7%) as high stroke risk(score≥ 2). According to the HAS-BLED score,594 cases(70.8%) of patients with NVAF were defined as low bleeding risk,245 cases(29.2%)as high bleeding risk.2.Among 839 patients with NVAF,157cases(18.7%) were treated with anticoagulant, 71(8.5%) cases were treated with anticoagulant and anti-platelet drug and 474 cases(56.4%) were treated with anti-platelet drug. The rates of anticoagulant of patients with paroxysmal atrial fibrillation, persistent atrial fibrillation, long persistent atrial fibrillation and permanent fibrillation were 17.1%、26%、18.1%、27.3% respectively, and the rates of anticoagulant and anti-platelet drug were 9.9%、10.5%、 4.3%、0 respectively, the usage rate of warfarin and dabigatran had no statistical difference between groups. The rates of anticoagulant of low stroke risk, intermediate stroke risk and high stroke risk were 37.5%、26.3%、15.8% respectively, and the rates of anticoagulant and anti-platelet drug were 10.7%、6.1%、8.7% respectively, the usage rate of warfarin and dabigatran had no statistical difference within groups. The rates of anticoagulant of low bleeding risk and high bleeding risk were22.4%、9.8%, and the rates of anticoagulant and anti-platelet drug were 3.9%19.6%, the usage rate of warfarin and dabigatran had statistical difference within groups.77.4%(144/186) of patients’INR level was within the range of 1.0-1.5. Only 11.7%(22/186) of patients’INR met the target INR levels(2.0-3.0). Average INR was 1.32±0.54.3.Single factor variance analysis showed that sex, age(>65 years), coronary heart disease, MI, after PCI, after radio frequency ablation of AF, hypertension, tumor, vascular diseases and cardiologists affected the selection of antithrombotic scheme. Age(>65 years), coronary heart disease, after radio frequency ablation of AF, combination of anti-platelet drugs, cardiologists affected the selection of anticoagulant. Logistic regression showed that age(>65 years), coronary heart disease, after PCI, after radio frequency ablation of AF, hypertension, tumor, vascular diseases and cardiologists were more closely related to the selection of antithrombotic scheme. After radio frequency ablation of AF, cardiologists were more closely related to selection of anticoagulant.Conclusion:l.The rate of anticoagulants was low and the usage was unreasonable.2.Among patients treated with warfarin, more than 4/5 were below the target INR levels(2.0-3.0), which indicates that the efficient of warfarin was low.3.Cardiologists are inclined to use warfarin. Doctors are inclined to use dabigatran for the NVAF patients who achieve radio frequency ablation...