Retrospective Study Of Application Status In Patients With Non-valvular Atrial Fibrillation Warfarin

Objective: A retrospective study to investigate the current status of non-valvular atrialfibrillation patients at high risk of warfarin.Methods: Collected292cases of hospitalization in the Fujian Provincial Hospital fromJanuary2008to09January CHADS2score greater than or equal to2points withnon-valvular atrial fibrillation patients as research object:1. Observed hospitalantithrombotic treatment, and analysis of possible factors that affect treatment decisions.2.Divided into long-term warfarin, long-term antiplatelet group and no antithrombotic groupaccording to long-term drug use, by telephone, access to the Provincial hospital recordsfollowed-up antithrombotic drug application, warfarin monitoring the situation,embolization and bleeding events, time of occurrence evaluated. Further depending onwhether the monitoring of INR is divided into adjusted-dose warfarin, constanted-dosewarfarin，compare adjusted-dose of warfarin group,constanted-dose warfarin group, and noantithrombotic group embolism, bleeding event occurrence.Result:1.292cases of hospitalized patients with warfarin25.4%(74/292), the antiplatelet44.5%(130/292), no antithrombotic30.1%(88/292); previous cerebrovascular events, coronaryheart disease, whether treatment of Cardiology doctor is the possible factors affectingtreatment decisions (P=0.015,0.038,0.000); Multinomial Logistic Regression, onlyprevious cerebrovascular events and treatment of Cardiology doctor is the independentfactor affecting the antithrombotic decision-making (P=0.003,<0.001).2. Long-term warfarin group9.0%(26/292), including monitoring of the PT-INR5.5%(16/292), long-term antiplatelet46.2%(135/292), no antithrombotic was31.8%(93/292).3. There was no significant difference between long-term warfarin group and long-termantiplatelet group in embolism incidence, and the risk of severe bleeding was4.2timeshigher (OR=5.192,95%CI:1.617-16.669, P=0.011);4. Compared with no antithrombotic group, long-term antiplatelet group embolism riskreduced by52.6%(OR=0.474,95%CI:0.295-0.761, P=0.002), and can reduce the cumulative embolism incidence, without increasing severe bleeding risk;5. Compared with no antithrombotic group, dose adjustment of warfarin group Embolismin risk reduction (P=0.003), and a serious risk of bleeding is not increased; compared withno antithrombotic group, no statistically constant dose warfarin group embolismrisk differences, but the risk of severe bleeding increased by17.6times (OR=18.600,95%CI:3.881-89.140, P=0.001);Conclusion: There are low application rate and less standardized medication in warfarinapplication status，we should raise the attention of the application to adjusted-dosewarfarin,who can not do the monitoring of patients can choose to anti-platelet replacementtherapy insteaded.