A Survey Of Anticoagulation Therapy Of Nonvalvular Atrial Fibrillation In Elderly Patients

OBJECTIVETo investigate the current status of antithrombotic treatment in elderly patientswith nonvalvular atrial fibrillation．The general features were recorded and riskfactors of stroke thromboembolism were estimated in order to provide data forclinical treatment.METHODSThe total of428elderly inpatients and outpatients with nonvalvular atrialfibrillation in8grade Ⅲ general hospitals in Beijing were chosen as researchobject during November2011to February2013． Observed hospitalantithrombotic treatment, and analysis of possible factors that affect treatmentdecisions. Divided into long-term warfarin, long-term antiplatelet group and noantithrombotic group according to long-term drug use. Male and female cases were249(58.18%)and179(41.82%) respectively．Mean age was （78.45±7.84）yearsold． Among all these thromboembolism events，153cases(93.87%)werestroke．Non-rheumatic heart disease AF risk levels were quantified using theCHADS2index. One point each was given for patients with congestive heart failure,hypertension，advanced age(≥75years)and diabetes mellitus, and2points to thosewith prior ischemic stroke and transient ischemic attack. Patients with aCHADS2score of0were classified as low risk,1as moderate risk and2or more ashigh risk. Non-rheumatic heart disease with AF was high risk embolism.81.78%of the patients were classified into high risk group,14.02%into moderate risk, and4.21%into low risk. Among these patients, aspirin was prescribed in183patientsby physicians,16were treated with clopidogrel, warfarin was suggested to78patients by physicians,8were treated with dabigatran and76patients were givennothing antithrombotic therapy. According to stroke risk level, there were350patients were suggested to use warfarin and the practical percent of using warfarinwas25.43%(89/350).Previous bleeding events and ege are the possible factorsaffecting treatment decisions. Of the total patients received warfarin，includingmonitoring of the international normalized ratio (INR)73.08%(76/104)．Theaverage level of INR was(1.79±0.61)．And patients’ INR being between2.0and3.0was28cases，which percentage was26.92%.And INR being between1.6and2.5was35cases，which percentage was33.65%.CONCLUSIONWith ages growing， the incidence of thromboembolic complicationsincreasing．The higher CHADS2score, the higher risk level of thromboembolicevents. CHADS2score has a reliable predictive value about vascular events.Warfarin is underused in elderly patients with NVAF who had indications ofanticoagulation．For the elderly patients with NVAF，age, hypertension, heartfailure and history of bleeding are the main factors affecting receivinganticoagulant therapy.