Comparison Of Efficacy And Safety Of Rivaroxaban And Warfarin In Anticoagulation Therapy In Elderly Patients With Non-valvular Atrial Fibrillation

Objective: To compare the safety and effectiveness of the new oral anticoagulant rivaroxaban and warfarin in elderly patients with nonvalvular atrial fibrillation.Provide more clinical evidence for drug use in elderly patients with non-valvular atrial fibrillation.Methods: Non-valvular atrial fibrillation was selected from Wanjishan Hospital of Wannan Medical College between 2018.08.01-2018.12.31,aged> 70 years,CHA2DS2-VASc score ? 2 points for men,? 3 points for women,and 3 points for HAS-BLED.There were 82 patients.Collect general clinical data such as patient's age,weight,previous medication status,improve blood routine,liver and kidney function,coagulation routine,and cardiac color Doppler ultrasound,exclude valve atrial fibrillation,contraindication to anticoagulation,and assess the risk of embolism and bleeding.Patients were divided into 2 groups according to their wishes: in the experimental group,a fixed dose of rivaroxaban 20 mg or 15 mg once a day;in the control group,the dose of warfarin was adjusted once a day to control the INR between 2-3.There were 37 cases in the control group and 45 cases in the experimental group.Regular follow-up calls or outpatient visits will be performed after the administration.Once a month,the patients will be monitored for medication compliance and asked if there is any bleeding and blood routine,urine routine,stool routine + occult blood,liver and kidney function.At the beginning of follow-up in March,June and December,each patient was given a color Doppler ultrasound,peripheral vascular Doppler ultrasound,and skull CT to determine whether there were mural thrombosis,stroke,and peripheral arterial thromboembolism.Results: A total of 70 people completed the experiment in this study,of which 91.1% of the experimental group completed the experiment,8.9% withdrew halfway,and 78.4% of the control group completed the experiment,21.6% withdrew halfway,P> 0.05.The difference was not statistically significant.In terms of embolism events,the incidence of ischemic stroke in the experimental group was 2.4%,the incidence of extracranial embolism was 0%,and the incidence of total embolism was 2.4%,which were lower than those in the control group.In the bleeding events,the actual values of the major,non-major bleeding,and total bleeding events(9.8%,0%,and 9.8%)in the experimental group were smaller than those in the control group(24.1%,3.4%,27.6%).but p> 0.05,the differences were not statistically significant.In terms of liver and kidney function,there was no statistical difference in aspartate aminotransferase,alanine aminotransferase,and creatinine clearance before and after treatment in the two groups.Conclusion: In the anticoagulation treatment of elderly patients with non-valvular atrial fibrillation,the effectiveness and safety of rivaroxaban are not inferior to warfarin.It is worth promoting in the clinic;however,the compliance of rivaroxaban and warfarin in elderly non-valvular atrial fibrillation patients is not very high,and health education needs to be strengthened.