Effect Of Standardized Warfarin Anticoagulation On Psychology And Quality Of Life In Patients With Cardiogenic Cerebral Embolism

Objective:To compare the effect between the standardized warfarin anticoagulation and antiplatelet agents on the psychology and quality of life in patients with cardiogenic cerebral embolism.Furthermore,the anxiety and depression of patients with cardiogenic cerebral embolism under different anticoagulation quality were compared retrospectively,so as to provide reference for improving the rate and compliance of warfarin anticoagulation treatment,improving the quality of anticoagulation treatment and popularizing anticoagulation clinics.Methods:1.Between January 2016 and March 2017,we enrolled 201 consecutive patients with cardiogenic cerebral embolism who were admitted to the Department of Neurology and Emergency Department of the Affiliated Hospital of Yangzhou University.Of whom 107 patients accepted warfarin anticoagulation therapy and then followed up warfarin anticoagulation regularly at clinic.94 patients refused warfarin and received antiplatelet therapy.The basic data of the two groups were collected and the Self-rating Anxiety Scale(SAS),self-rating depression scale(SDS)and the Mos36-item Short Form Health Survey were completed on the 3rd day,1,3,6,9 and 12 months after onset respectively.The anxiety,depression and quality of life of the two groups were evaluated and compared.2.The basic data of 107 patients who agreed to warfarin anticoagulation therapy were collected,including the time in therapeutic range(TTR)of warfarin.To compare the anxiety and depression of patients with cardiogenic cerebral embolism treated with TTR ≥ 58% and TTR < 58%,so as to analyze the influence of different anticoagulation treatment quality on anxiety and depression.Results:1.The total incidence of psychological disorders after cardiogenic cerebral embolism was 45.3%,and the incidence of post-stroke comorbid anxiety and depression was 31.8%.2.Compared with the antiplatelet group,the recurrence rate of cerebral infarction in the warfarin anticoagulant group was lower,and the difference was statisticallysignificant.There was no significant difference in the incidence of bleeding complications.3.The scores of SAS and SDS in warfarin anticoagulant group were significantly lower than those at baseline at the end of follow-up,and there was no significant difference in the changes of SAS and SDS scores in the antiplatelet group during follow-up.The SAS and SDS in the anticoagulant group were significantly lower than those in the antiplatelet group at 3,6,9 and 12 months.At the end of the follow-up period,the score of the Mos 36-item Short Form Health Survey(PCS,MCS)was significantly increased in the warfarin anticoagulant group;the score of PCS was significantly increased in the antiplatelet group,but there was no significant difference in the change of the score of MCS;At 12 months,the total score of mental health(MCS)in the anticoagulant group was significantly higher than that in the antiplatelet group.4.The TTR was 62.1±10.3% in patients with cardiogenic cerebral embolism who followed up regularly in the anticoagulant clinics of the hospital and the anticoagulant effect was satisfactory.5.There was no significant difference in the proportion of patients with anxiety and depression between TTR(≥ 58%)and TTR < 58% at the end of 12 months follow-up.There was a significant difference of the SDS descending value between the two groups of patients;and no significant difference in the SAS descending value.Conclusions:Standardized warfarin anticoagulant therapy and regular treatment in anticoagulant clinics can reduce the recurrence of cardiogenic cerebral embolism without increasing the risk of anticoagulant hemorrhage,and significantly improve the anxiety and depression of patients and improve the quality of life.The high anticoagulation quality of warfarin is conducive to the improvement of depression in patients with cardiogenic cerebral embolism.