Safety And Efficacy Of NOACs In Patients With Non-valvular Atrial Fibrillation

Background and objectiveIn recent years,the burden of atrial fibrillation and atrial fibrillation related stroke has increased significantly in China,but the anticoagulation rate in Chinese population is still low,and there is still a lack of related studies on the safety and efficacy of warfarin and new oral anticoagulant agents(dabigatran,rivaroxaban)in patients with non-valvular atrial fibrillation in China.The aim of this study was to investigate the safety and efficacy of warfarin,dabigatran and rivaroxaban in patients with nonvalvular atrial fibrillation,compared to antiplatelet agents.MethodsThis study included 294 non-surgical patients who were hospitalized in Ruijin Hospital for atrial fibrillation or accompanying with atrial fibrillation from January 1,2015 to December 31,2017.They were divided into antiplatelet groups,the warfarin group,the dabigatran group,and the rivaroxaban group according to the type of antithrombotic drugs,we observed the occurrence of thromboembolic events,bleeding events,allcause deaths during December 31,2018? ResultsThe rate of thromboembolic events of dabigatran group and rivaroxaban group was lower than the antiplatelet group(P<0.05),however,no significant difference with the warfarin group(P>0.05);There was no significant difference in the incidence of thromboembolic events between the dabigatran group and the rivaroxaban group(P>0.05).There was no significant difference in the rate of bleeding events between the dabigatran group ?the rivaroxaban group?the warfarin group and the antiplatelet group(P>0.05).The incidence of extracranial hemorrhage was significantly increased in the dabigatran group,compared to the antiplatelet group(P<0.05).The all-cause mortality rate of the dabigatran group was lower than that of the antiplatelet group(P<0.05),but there was no significant difference between the dabigatran group and the warfarin group(P>0.05);the all-cause mortality of the rivaroxaban group was not differentiated with the warfarin groups or the antiplatelet group(P>0.05);there was no significant difference in all-cause mortality between the dabigatran group and the rivaroxaban group(P>0.05).ConclusionThe efficacy of dabigatran and rivaroxaban in preventing thromboembolic events in patients with non-valvular atrial fibrillation is not inferior to warfarin,without increasing the risk of bleeding ? Compared to antiplatelet therapy,dabigatran can reduce the risk of thromboembolic events and all-cause mortality,but may increase the risk of extracranial hemorrhage.