An Observational Study Of Novel Oral Anticoagulants In Elderly Patients With Nonvalvular Atrial Fibrillation

Background:Atrial fibrillation(AF)is one of the most common tachyarrhythmias in the clinic.In recent years,the prevalence of AF has increased year by year.A cross-sectional survey in San Diego,Spain in 2013 showed that the prevalence of AF in hospitalized patients up to 2.08%,it will bring a heavy burden to the social economy.AF is an age-related disease,with elderly patients older than 75 years accounting for 45%of the total AF population.In order to prevent thromboembolic events caused by AF,especially ischemic stroke,the guidelines recommend those who has a high or medium risk of thromboembolic events to start oral anticoagulant therapy.Older elderly patients often have a high risk of embolism as well as a high risk of bleeding,and it's complicated to choose their anticoagulants.The efficacy of new oral anticoagulants(NOACs)is similar to that of the traditional vitamin K antagonist warfarin,but it is relatively safer.At present,the common NOACs in China include rivaroxaban and dabigatran,but there is a lack of information on the application of the two drugs in the real world in our country..Objective:To compare the efficacy and safety of rivaroxaban and dabigatran in elderly patients with AF,and to analyze the application of the drugs in special groups such as patients with chronic kidney disease(CKD),malignant tumors and anti-platelet therapy,giving more evidence for the application and dose adjustment of NOACs in the elderly population in China.Methods:A total of 202 elderly AF patients were enrolled in the Department of Cardiology of our hospital from September 2016 to March 2018.The patients were divided into the rivaroxaban group and the dabigatran group according to the NOACs used.The clinic information and baseline test results were recorded.Then there is a 9-month long follow-up.The changes of relevant laboratory indicators and new embolization and bleeding events were recorded during the follow-up period,and a subgroup analysis was performed.Results:The median age of the rivaroxaban group was 84 years.The average score of CHA2DS2-VASc was(4.41±1.7),the average score of HAS-BLED was(3.1±1.7),and the efficacy rate was 96.6%(112/116)while the bleeding rate is 12.9%(15/116).The median age of dabigatran group was 83 years old,the average score of CHA2DS2-VASc was(4.42±1.4),the average score of HAS-BLED was(3.0±1.3),the efficacy rate was 95.3%(82/86),and bleeding rate is 11.6%(10/86).The baseline was comparable between the two groups,and there was no significant difference in efficacy and safety(P=0.945,P=0.781).Chronic kidney disease(CKD),malignant tumors,and antiplatelet therapy have no significant effect on efficacy and safety of the two drugs.Conclusions:There was no significant difference in the efficacy and safety of rivaroxaban and dabigatran in elderly patients with AF.CKD,malignant tumors,and antiplatelet therapy had no significant effect on the efficacy and the safety of the two drugs.Conclusions:There was no significant difference in the efficacy and safety of rivaroxaban and dabigatran in elderly patients with AF.CKD,malignant tumors,and antiplatelet therapy had no significant effect on the efficacy and the safety of the two drugs.