Applications Commonly Used Antithrombotic Drugs In Patients With Atrial Fibrillation With Chronic Kidney Disease

BackgroundChronic kidney disease (CKD) affects about10%of adults and is associated with increased rates of cardiovascular disease. In a large observational study of outpatients with atrial fibrillation, about one third had stage3or4CKD and an estimated GFR (eGFR) of45ml/min per1.73m2, which was found to be an independent predictor of stroke. Anticoagulation with adjusted-dose warfarin reduces the risk of stroke in patients with nonvalvular atrial fibrillation by about two-thirds, based on consistent results of several randomized trials, but its efficacy in CKD patients with atrial fibrillation has not been specifically established. In hemodialysis patients with atrial fibrillation (excluded from participation in randomized trials to date), recent observational studies have challenged the value of warfarin anticoagulation, leading to doubts about whether results of randomized trials can be reliably extrapolated to CKD patients. AF in patients with CKD and a high CHADS2score (2points) is associated with a poor outcome and vitamin K antagonist therapy is recommended to reduce mortality and the risk of stroke.So, the primary objective of this study was to assess the impact of warfarin therapy on estimated GFR in elderly patients with CKD and AF. Our secondary objective was to assess the impact of warfarin therapy on thromboembolism and haemorrhage in these patients.Objective:1. Collect and describe the characteristics of clinical baseline of patients with atrial fibrillation;2. Analyze the stroke and bleeding risk stratification of patients with atrial fibrillation combined with chronic kidney disease, and the usage of anticoagulant drugs in layered patients;3. Research the influence of different anticoagulant drugs on stroke and haemorrhage risk; 4. Research the influence of different anticoagulant drugs on kidney function among the patients with atrial fibrillation combined with chronic kidney disease.Research methods:1. Using retrospective study method The study object is patients with non-valvular atrial fibrillation in our hospital from January2013to January2014,399cases:the patients with CHADS2scoring under1and chronic kidney disease stage under3are classified as low risk group. The number of cases that meet this requirement completely reaches53people:the26patients that don’t receive anticoagulant drug treatment are called Group A; the other27patients that receive aspirin drug treatment are called Group B. The patients with CHADS2scoring above1and chronic kidney disease (CKD) stage for3to5are divided into the mid-and high-risk group. The cases that accords with this requirement completely are61:the patients receiving aspirin drug treatment are35(Group C); the patients receiving warfarin therapy group are26(Group D).2. We detect and count INR values of patients with chronic kidney disease combined with non-valvular atrial fibrillation and evaluate different anticoagulation intensity of anticoagulant drugs in every layer.3. We analyze the incidence of severe thromboembolic and massive haemorrhage events in the patients since using drug within1year and evaluate prognosis effects of different anticoagulation drugs on the risk stratification of atrial fibrillation.4. We calculate and count the glomerular filtration rate (GFR) of patients, and evaluate the influence of different anticoagulant drugs on renal function of patients with atrial fibrillation combined with chronic kidney disease.5. t test is applied to the statistical checkout of continuous variables between the two groups, rank sum test and non-parametric statistical test that fisher’s exact test is used in two groups. Use Logistic regression analysis for the possible influencing factors. The inspection standard is0.05.Results:1. This study were included399cases of patients with non-valvular atrial fibrillation,199cases combined with chronic kidney disease:the patients with CHADS2scoring under1and chronic kidney disease stage under3are classified as low risk group accounting for26.6%(53/199):Group A that doesn’t receive anticoagulant drug treatment accounts for49.1%(26/53); Group B that receives aspirin drug treatment accounts for50.9%(27/53). The patients with CHADS2scoring above land chronic kidney disease (CKD) stage for3to5are divided into the mid-and high-risk group: Group C receiving aspirin drug treatment are up to42.6%(26/61); the Group D receiving warfarin therapy group are up to57.4%(35/61).2. The INR values of low-risk group that did not receive anti-coagulant drugs (Group A) and received aspirin treatment group (Group B) are respectively1.2±0.3and1.4±0.3; the INR values of mid-and high-risk group that received aspirin treatment (group C) and warfarin therapy group (group D) are1.5±0.4and2.2±0.4.3. The incidence of severe thromboembolic in low-risk group that did not receive anti-coagulant drugs (Group A) and received aspirin treatment group (Group B) is respectively7.6%(2/26) and7.4%(2/27); the incidence of severe thromboembolic in mid-and high-risk group that received aspirin treatment (Group C) and warfarin therapy group (Group D) is respectively26.9%(7/26) and5.7%(2/35).4. The incidence of massive haemorrhage in low-risk group that did not receive anti-coagulant drugs (Group A) and received aspirin treatment group (Group B) is respectively3.8%(1/26) and7.4%(2/27); the incidence of massive haemorrhage in mid-and high-risk group that received aspirin treatment (Group C) and warfarin therapy group (Group D) is respectively7.6%(2/26) and14.2%(5/35).5. The GFR in low-risk patients that did not receive anti-coagulant treatment has no significant changes before and after the treatment, but the GFR in the group receiving aspirin treatment is higher after the treatment than before (P<0.05); The GFR in mid-and high-risk group that receives aspirin treatment has no significant changes before and after the treatment, but the GFR in the group receiving warfarin treatment is higher after the treatment than before (P<0.05);Conclusion:1. Among patients with atrial fibrillation in the low-risk group, aspirin anti-coagulant therapy fails to make the INR values up to standard (2.0-3.0); In the high-risk group of patients with atrial fibrillation, warfarin anti-coagulant treatment intensity reaches standard and is superior to aspirin.2. The incidence of severe thromboembolic in group that received anti-coagulant treatment and received aspirin treatment group has no significant difference; Among the patients with atrial fibrillation in the high-risk group, warfarin anti-coagulant therapy for preventing thromboembolism has better therapy effect than aspirin.3. The incidence of massive haemorrhage among patients with atrial fibrillation in low-risk group that did not receive anti-coagulant drugs and received aspirin treatment has no significant difference; among patients with atrial fibrillation in the high-risk group, the difference between warfarin anti-coagulant therapy and aspirin anti-coagulant treatment group was indistinctive.4. Among patients with atrial fibrillation in the low-risk group, aspirin anti-coagulant treatment group can improve the glomerular filtration rate of patients with chronic kidney disease; but in the mid-and high-risk patients aspirin for the improvement of renal function is not observed, and warfarin can improve the glomerular filtration rate in the mid-and high-risk group.