The Comparative Study Of Aspirin Combined Naoxintong And Adjusted-dose Warfarin In Preventing The Thromboembolism Of Elderly Patients With Nonvalvular Atrial Fibrillation

ObjectiveAdjusting warfarin dose in different individuals to both safe and effective range, is a very difficult issue in long-term clinical applicationCompared with adjusted-dose warfarin, to investigate the curative effect of aspirin combined naoxintong(combined group) in preventing the thromboembolism of elderly patients with high risk of nonvalvular atrial fibrillation (NVAF).Methods189patients with high risk of NVAF were selected from Fujian Provincial Hospital in August2010to March2011. The patients were65-74years-old with hypertension, diabetes or proven coronary artery disease or75years-old and above (CHA2DS2-VASc score≥2). PCR-RFLP technology was used to genotype the vitamin K2,3-epoxide reductase complex subunit1(VKoRC1-1639G/A) polymorphisms in these patients.151eligible enrolled patients whose vitamin K2,3-epoxide reductase complex subunit1(VKoRC1) genotype were mutational were divided into two groups according to the patients’will.76in the warfarin group took warfarin (control INR within2to3).75in the combined group used aspirin (100mg/d) combined naoxintong (1.6g*3/d) as anti-thrombotic drug. All took drug at least1year and clinical events including ischemic stroke, total haemorrhage, minor haemorrhage and the all-cause death rate were followed up.Results1. The frequency of the VKORC1-1639AA. GA. GG genotypes which was in agreement with Hardy-Weinberg equilibrium(P>0.05) in the189patients were79.9%(151/189),17.5%(33/189) and2.6%(5/189), respectively.2. There were no statistical differences of general data including gender, age, and smoking history, accompanying diseases, drug use, the distribution of heart function and CHA2DS2-VASc score between two groups (P>0.05).3. In terms of the risk of ischemic stroke, no statistical difference was found between combined group and warfarin group (5.3%vs1.3%, P=0.209).4.There were no statistical differences of total haemorrhage (5.3%vs11.8%, P=0.245), minor haemorrhage (5.3%vs3.9%, P=0.719) and the all-cause death rate (10.7%vs6.6%, P=0.371) between combined group and warfarin group (P>0.05). The serious bleeding rate of the combined group and the warfarin group were, respectively,0.0%and7.9%; they have a significant difference (OR=0.921,95%CI0.862-0.984, P=0.028)ConclusionsCompared with adjusted-dose warfarin, aspirin combined naoxintong can also reduce the risk of ischaemic stroke and the risk of serious bleeding in the VKORC1-1639AA genotype patients with high risk of nonvalvular atrial fibrillation (NVAF).