Clinical Efficacy And Safety Of A Novel Oral Anticoagulant In Elderly Patients With Nonvalvular Atrial Fibrillation And Heart Failure

Background Atrial fibrillation(AF),referred to as atrial fibrillation,is a type of tachyarrhythmia characterized by palpitation and chest tightness.Non-valvular atrial fibrillation(non-valve atrial fibrillation(NVAF))refers to atrial fibrillation without mechanical artificial heart valve or moderate to severe mitral stenosis.At present,the incidence of atrial fibrillation is about 0.65%.Among them,non-valvalr atrial fibrillation(NVAF)accounted for about 65.2%.In atrial fibrillation,the heart loses its normal rhythm,which affects blood flow and increases the risk of life-threatening thrombosis and embolism,especially in older patients.Atrial fibrillation is an important risk factor for heart failure,and heart failure is becoming the most important cardiovascular disease in this century,known as "the last battlefield of cardiovascular diseases in the 21 st century".In the clinical diagnosis and treatment of elderly patients with NVAF complicated with heart failure,attention should be paid to anticoagulation therapy.Effective anticoagulation therapy can prevent thrombosis and reduce the risk of cardiovascular and cerebrovascular embolism,so as to improve the survival rate of patients.Traditional anticoagulant drug warfarin can play an anticoagulant effect and reduce the incidence of stroke through its effects in vivo and in vitro,respectively.However,warfarin has some problems,such as slow onset,narrow therapeutic window,and difficult to monitor international normalized ratio(INR)index.In the process of clinical promotion encountered obstacles.Since the 21 st century,various new oral anticoagulants have been developed,among which Dabigatran and rivaroxaban are the representatives,and they have been used more and more widely in NVAF patients in recent years.Dabigatrun is a direct thrombin inhibitor that prevents fibrinogen from cracking into fibrin,thereby blocking the final step of the clotting cascade network and rapidly acting as an anticoagulant.There is little interaction with other drugs and food,so the individual dose difference is small,INR value does not need to be monitored during medication,the usage is simple and the compliance is high.Large clinical studies have established Dabigatron as an alternative to warfarin in the prevention of stroke or systemic thrombosis in patients with nonvalvular atrial fibrillation.The mechanism of action of rivaroxaban is to prevent thrombus formation by selectively blocking the active site of Factor Xa,which also acts on the common pathway of endogenous and exogenous clotting pathways.Objective This study was to investigate the anticoagulant effect and safety of Dabigatran,rivaroxaban and warfarin in elderly patients with nonvalvular atrial fibrillation complicated with heart failure,and the anticoagulant effect of dabigatran on patients with heart failure of different types and degrees.To provide clinical basis for optimizing anticoagulant drug selection for these patientsMethods and Analysis A retrospective study was conducted to select 272 elderly patients with NVAF and heart failure who received long-term anticoagulant therapy in outpatient or inpatient department of our hospital from January 2018 to December 2022.According to long-term drug use,116 patients were divided into dabigar group,91 patients in warfarin group and 65 patients in rivaroxaban group.In addition,all three groups were treated with conventional antiarrhythmic agents and antiheart failure agents.The efficacy and safety of anticoagulation were observed and compared in each group after treatment.Then telephone follow-up was used,and the follow-up was conducted simultaneously with the review of hospitalized cases.The efficacy and safety of anticoagulation were evaluated according to embolic events,bleeding events and adverse reactions.Results In the safety evaluation,8 patients(6.9%)in Dabigar group had bleeding events,which was lower than that in Rivaroxaban group(6 patients(9.2%)and warfarin group(16 patients(17.6%).The difference in the total number of patients with bleeding was statistically significant(p < 0.05).The mild bleeding rate of Dabigar group(6.9%)was lower than that of Rivaroxaban group(7.7%)and warfarin group(15.4%),and the difference was statistically significant(p < 0.05).Adverse events occurred in 2 patients(3.1%)in the rivaroxaban group,which was lower than that in the Dabigat group(6patients(5.2%)and that in the Warfarin group(16 patients(17.6%).The incidence of adverse events in the Warfarin group was statistically significant compared with that in the Rivaroxaban group and Dabigat group(p < 0.05).The incidence of gastrointestinal discomfort in the Rivaroxaban group(3.1%)was lower than that in the Dabigar group(3.4%)and that in the Warfarin group(20.9%).The incidence of gastrointestinal discomfort in the Warfarin group was significantly different from that in the Rivaroxaban group and the Dabigar group(p < 0.05).In the effectiveness evaluation,the new oral anticoagulants Rivaroxaban and Dabigatran showed better anticoagulant effect than the traditional anticoagulants of warfarin,and no embolization events occurred.Research conclusion For the anticoagulant treatment of elderly patients with nonvalvular atrial fibrillation complicated with different types and degrees of heart failure,the new oral anticoagulant drugs Rivaroxaban and Dabigatran showed better anticoagulant effect than the traditional anticoagulant drugs warfarin,and no embolization events occurred.And the safety is good,manifested in the new oral anticoagulant bleeding incidence is low,and most of the bleeding is mild;The incidence of adverse reactions is low.