The Clinical Situation Analysis Of Antithrombotic Treatment And Stroke In Elderly Patients With Non-vavular Persistent Atrial Fibrillation

Objective: To provide reference for narrowing the gap between present status of treatment and guidelines,we analyzed the clinical characteristics,antithrombotic treatment and stroke in elderly patients with non-valvular persistent atrial fibrillation in our clinical center.Methods: This is a retrospective study.Elderly in patients with non-valvular persistent atrial fibrillation in the first affiliated hospital of China medical university from January 1,2015 and June 30,2017 were registered for this study.Patients were divided into two groups by age: 65-74 years old were Group 1(N=134)and older than 75 years old were Group 2(N=166).CHA2DS2 VASc score was calculated to assess risk of thromboembolic events,and bleeding risk was evaluated according to HAS-BLEDscore.Baseline data,clinical characteristics and the status of antithrombotic treatment(no antithrombotic treatment,antiplatelet agents,oral anticoagulants,NOAC + antiplatelet agents,VKA+antiplatelet agents)during hospitalization were recorded.Patients discharged from hospital received follow-up after 7 days,90 days,180 days,360 days to know the situation of the usage of antithrombotic drug and the occurrence of stroke.Results: 1.A total of 300 patients were registered for this study.134 patients were in Group 1;51 patients(38.1%)were female;mean age was 69.31±2.94 years old;mean BMI was 25.79±4.30 kg/m2.166 patients were in Group 2;86 patients(51.8%)were females;mean age was 80.12±3.81 years old;mean BMI was 23.91±4.21kg/m2.We compared the baseline data between the two groups and found the number of female in Group 2 was more(P < 0.05),BMI of Group2 was lower(P < 0.05),the number of dilated cardiomyopathy in Group2 was less(P < 0.05),D-D in Group2 was higher(P<0.05),e GFR in Group2 was lower(P < 0.05),the mean size LAD in Group2 was lower(P<0.05)However,there was no significant difference in other items between the two groups(P > 0.05).The first three coexisting diseases of atrial fibrillation were hypertension,coronary heart disease,and heart failure.2.The mean of CHA2DS2-VASc score of all the 300 patients was 3.70±1.47,and 287patients(95.7%)had score ?2.CHA2DS2-VASc score in Group 2 was higher than Group 1(P < 0.05).The mean of HASBLED score was 1.95±0.75,and 237 patients(79.0%)had HASBLED score < 3.HASBLED score in Group 2 was higher than Group 1(P < 0.05).For patients with CHA2DS2-VASc score ?2,16.70% of patients received no antithrombotic therapy,42.20% received pure antiplatelet drug therapy,41.10% received anticoagulant treatment,7.70% received pure warfarin,27.20%received NOAC,4.90% received NOAC + antiplatelet,1.40% received warfarin+antiplatelet.There was no significant difference in the antithrombotic therapy between the two groups.In the first half year of 2015,the proportion of anticoagulant treatment was 23.70% and the proportion of NOAC was 16.90%.In the latter half of 2015,the proportion of anticoagulant therapy was 28.35%,and NOAC was 17.00%.In the first half of 2016,the anticoagulation ratio was 48.10% and the NOAC proportion was23.10%.In the latter half of 2016,the proportion of anticoagulant therapy was 55.60%,and NOAC was 37.00%.In the first half of 2017,the anticoagulation ratio was 49.30%,and the NOAC proportion was 39.10%.3.After discharge,follow-ups were done for patients with CHA2DS2-VASc score ?2.287 patients had follow-ups of 7 days and 90 days,228 patients had follow-ups of 180 days,172 patients had follow-ups of 360 days.During the 7 days follow-up,118 patients received anticoagulant therapy,77 patients(65.0%)had good treatment compliance.During the 90 days follow-up,58 patients(49.2%)had good treatment compliance.During the180 days follow-up,91 patients received anticoagulant therapy,35 patients(38.5%)had good treatment compliance.During the 360 days follow-up,60 patients received anticoagulant therapy,and 15 patients(25%)had good treatment compliance.4.Older than 75 years old(OR: 4.284,95%CI:1.315-18.585),previous stoke/TIA(OR:4.943,95%CI: 1.391-13.190)were risk factors for stroke,and anticoagulation(OR:0.023,95%ci :0.083-0.858)was an important factor in preventing stroke.Conclusion1.Ratio of anticoagulation therapy in elderly patients was low,and drug compliance is poor.The anticoagulation ratio of elderly patients with non-valvular persistent atrial fibrillation increased year by year,especially the usage of NOAC.2.Age,history of stroke and anticoagulation treatment are the important influencing factors of stoke in elderly patients with non-valvular persistent atrial fibrillation.