| Background:With aging society,the number of patients suffering from coronary heart disease combined with atrial fibrillation is rising.Clinically these Patients are treated with anticoagulant drugs or anticoagulant plus antiplatelet.For patients with atrial fibrillation,the main role of anticoagulants is to prevent the occurrence of ischemic stroke;but for patients with coronary heart disease,anticoagulants may reduce thrombosis after coronary plaque rupture,accordingly to abate patients' clinical symptoms and prevent acute myocardial infarction.Currently,two primary drugs,Rivaroxaban and Warfarin,are applied into mediation and numerous clinical data comparative analysis of the two drugs in effectiveness of preventing embolism in non-valvular atrial fibrillation and safety of bleeding risk has been developed.Basis on these researches,Rivaroxaban is recommended as an alternative to Warfarin,and even becomes the first choice.However,for such patients,it is not enough to discuss the effectiveness and safety of the two drugs in preventing embolism,and it is also necessary to observe the incidence of unstable angina in patients in order to make a more comprehensive comparative analysis of the effectiveness and safety of the two drugs.At present,the data in clinical trials rarely contain unstable angina,which leads to incomplete eventual ischemic and adverse events.And in patients with coronary heart disease combined atrial fibrillation who took aspirin,the clinical efficacy comparison data of Rivaroxaban and Warfarin were not sufficient.Coronary artery plaque rupture and exposure to the subcutaneous matrix of the coronary lineage can trigger adhesion,activation,aggregation and clotting coagulation cascade for platelet,which eventually lead to the formation of blood clots and result in unstable angina attacks also even acute myocardial infarction as well as other serious conditions.Because of the clotting reaction in the thrombosis mechanism,there may be differences in the size of blood clots and dissolution rate after coronary plaque rupture in patients who take Rivaroxaban or Warfarin.Therefore,for patients with combined coronary heart disease taking aspirin,increasing the incidence of ischemic events and adverse events of unstable angina can comprehensively assess the effectiveness and safety of the two drugs.Some researchers have tested Warfarin's preventive effect for acute myocardial infarction.The conclusion confirmed that the application of Warfarin could effectively reduce the incidence of acute myocardial infarction,but no country could incorporate it into the secondary preventive drug for coronary heart disease.Because some studies also have found that the clinical net benefit is offset by the risk of bleeding and it cannot reduce the all-cause mortality rate,besides,the prognosis effect is related to patient compliance and drug diet.Thus the efficacy of the drug is not stable enough.Rivaroxaban is a new type of oral anticoagulant with the stable efficacy,almost no reaction with other food or drugs.Although certain analysis showed the incidence rate of ischemic cardiovascular event in Rivaroxaban was less than Warfarin,however the inclusion criteria of it also included patients without a history of coronary heart disease..Thus,this cannot be used as a proof to recommend coronary heart disease combined with non-valve atrial fibrillation taking aspirin in elderly patients' medication.Whether effectiveness and safety of Rivaroxaban is superior to Warfarin of these patients needs further trials to prove.This analysis can provide further data support for the clinical medication of such patients and reduce clinical risk.Objective:In this retrospective analysis,elderly patients with coronary heart disease combined with non-valvular atrial fibrillation taking aspirin were divided into Rivaroxaban group and Warfarin group according to taking different anticoagulant drugs.Conducting statistics and analysis of ischemic events occurring in 6 months,so as to demonstrate the advantages and disadvantages of Rivaroxaban or Warfarin in such patients,and provide more data for clinical medication.Methodology:Analysis of patients suffering from coronary heart disease combined non-valve atrial fibrillation taking aspirin from June2017 to February 2019 in our hospital and other hospital,a total of 175 cases were eventually reported according to the discharge criteria.They are divided into the Rivaroxaban group and the Warfarin group on the basis of the use of Rivaroxaban and Warfarin.There were no statistical differences in age,sex,hypertension,diabetes,and history of embolism and hypercholesterolemia in both groups.But,there were statistical differences in CHA2DS2-VASc score.This retrospective analysis made statistical data on ischemic events occurred in two groups patients taking drugs within 6 months,and the data were statistically analyzed by SPSS22.0.Results:1.The incidence of ischemic events and incidence of adverse events in both of the Rivaroxaban group and Warfarin group were low.Via statistical analysis(P>0.05),there was no statistical difference;did not rule out the CHA2DS2-VASC score of Warfarin group was significantly lower than that of Rivaroxaban group,leading to no difference.2.The major bleeding rate of the Rivaroxaban group was lower than that of the Warfarin group and did not show statistically significant deference.(P>0.05).Conclusion:Among elderly patients with coronary heart disease and atrial fibrillation taking aspirin,compared with Warfarin,the incidence of ischemic events and incidence of adverse events in the Rivaroxaban group were lower from that of Warfarin and there was no statistically significant deference.In terms of safety,the incidence of major bleeding in Rivaroxaban also was lower than that of Warfarin and also no statistically significant deference.However,considering the inconvenience of applying,unstable efficacy,poor patient compliance of Warfarin,Rivaroxaban may be the safe and effective treatment for people at high risk of stroke. |
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