The Influence Factors Of Atrial Thrombosis In Patients With NVAF And The Comparison Of Anticoagulant Effect

Objective:To investigate the influencing factors of thrombosis in left atrial/left atrial auricular(LA/LAA)in patients with nonvalvular atrial fibrillation(NVAF)and Comparison of efficacy and safety of anticoagulant therapy.Methods:A total of 309 patients underwent transesophageal cardiac ultrasound examination were enrolled in our hospital From September 2016 to January 2018,then divided into LA/LAA thrombus group and non LA/LAA thrombus group according to transesophageal echocardiography(TEE),43 patients in the thrombosis group(33males)and 111 patients in the non-thrombosis group(73males),recording patient's previous medical history,general conditions,laboratory test results,transthoracic cardiac ultrasonography and TEE results,and then calculate CHA2DS2-VASCscore According to the general data of the patients.The differences of all the clinical indexes of two groups were respectively compare,the multiple factors logistic regression analysis to explore the dangerous factors of LA/LAA thrombosis.All patients were followed up for 1 year,11 patients with contact telephone number is wrong or not and out of the research object,a successful follow-up of143 patients,36 patients for not regular monitoring the use of anticoagulants or blood coagulation function and cardiac ultrasound and head MRI excluded,record the rest of the107 cases of patients with the occurrence of major adverse cardiac events,outcomes including bleeding,thrombus formation,stroke,death.Results :(1)There was no significant difference in gender,age,height,weight,smoking,drinking history,coronary heart disease,diabetes,hypertension,congestive heart failure,history of peripheral vascular disease and type of atrial fibrillation between the thrombusgroup and non thrombus group(P>0.05),CHA2DS2-VASC score and stroke were significantly higher than non thrombosis group(P<0.01);(2)Thrombusgroup,thePLT,PDW,RDW,NE,LY,NLR,D-dimer,fibrinogen,urea nitrogen,glucometerr,glycosylated hemoglobin,low/high density lipoprotein cholesterol,lipoproteina and creatine kinase,creatine kinase isoenzyme,troponin I,there were no statistically significant difference(P>0.05),MPV,BNP,creatinine,troponin T,gay cysteine,left atrial diameter(LAD),ejection fraction(LVEF)was statistically significantdifference(P<0.01);(3)In the use of aspirin and clopidogrelbetween the thrombosis group and the non-thrombosis groupwas no statistically significant difference(P>0.05),while between the use of warfarin?new anticoagulant drugs and lipid-lowering drugs there was statistically significant difference(P<0.05);(4)the results of binary classification logistics regression analysis indicated that stroke,homocysteine,left atrial diameterwere risk factors for thrombosis,and new anticoagulants were protective factors for thrombosis;(5)there were statistically significant differences in bleeding and death between the warfarin group and the neoanticoagulant group during the 1-year follow-up period(P<0.05),while in strokeandrethrombosiswerenotstatisticallysignificantdifferences(P>0.05).Conclusion:(1)stroke,homocysteine,LAD are independent risk factors for LA/LAA thrombosis.(2)The new anticoagulants are superior to warfarin in terms of safety and comparable to warfarin in terms of efficacy.