Research Of Oral Anticoagulants In Patients With Non-valvular Atrial Fibrillation

Objectives:To investigate the antithrombotic treatment status of patients with non-valvular atrial fibrillation in a Third-class hospital in Kunming.To analyze the factors that may influence the selection of antithrombotic regimens in patients with atrial fibrillation.To evaluate the efficacy,safety,and adherence of new oral anticoagulants in patients with non-valvular atrial fibrillation.To explore whether pharmacists participate in pharmaceutical care,provide medication education,and anticoagulant knowledge education to patients can improve patients’compliance with anticoagulant drugs and provide further protection for patients.Methods:1.The first part of this study was a single-center,retrospective study,which included patients with non-valvular atrial fibrillation from January 2020 to June2021.Baseline clinical data and drug treatment information were collected and the CHA₂DS₂-VASc score and HAS-BLED score were calculated and stratified.Evaluate the application of anticoagulant drugs and explore the reasons for not receiving anticoagulant treatment.Univariate analysis and logistic regression analysis were performed on influencing factors that may affect antithrombotic regimen and anticoagulant drug selection.2.The second part of this study was a single-center,prospective,observational study that enrolled patients with non-valvular atrial fibrillation who were taking new oral anticoagulants between August 2021 and January2022.The pharmacist explained the necessity of anticoagulation therapy and the precautions for the application of anticoagulant drugs to patients and their families,provided medication education for patients,and evaluated the compliance of anticoagulant drugs.Follow-up and medication education were conducted during the first and third months after discharge.Collect information on anticoagulant use,stroke events,cardiovascular events,bleeding events,death and more events,and conducted a questionnaire survey with anticoagulant medication compliance and anticoagulant knowledge for patients.Results:1.In the first part,342 patients with non-valvular atrial fibrillation were included.179 patients（52.34%）were treated with anticoagulant drugs;118 patients（34.50%）received antiplatelet drugs;45 patients（13.16%）did not receive anticoagulant drugs or anti-platelet drugs.The mean CHA₂DS₂-VASc score was 3.28±1.68.Only54.98%of patients at high risk of stroke received oral anticoagulant therapy.2.The logistic regression analysis of antithrombotic regimen selection showed that high risk of CHA₂DS₂-VASc stroke,increased bleeding risk（HAS-BLED≥3）,lacunar infarction,coronary heart disease,and respiratory failure were the independent influencing factors in the selection of antithrombotic regimens.The logistic regression analysis of anticoagulant drug selection showed that a history of lacunar infarction was an independent factor influencing anticoagulant drug selection.3.A total of 84 patients were included in part II,including 37 patients（44.05%）in the edoxaban group,15patients（17.85%）in the rivaroxaban group,and 32 patients（38.10%）in the dabigatran group.Only one patient taking dabigatran was lost to follow-up,and the other 83patients completed follow-up.During the follow-up period,there were 32 bleeding events,including 16 in the edoxaban group,8 in the rivaroxaban group,and 8 in the dabigatran group.The most common bleeding type was subcutaneous/mucosal bleeding,and there was no statistical significance in the bleeding events among the treatment groups（P>0.05）.There were statistically significant differences in rehospitalization events among the three groups（P<0.05）,while there were no significant differences in other adverse events（P>0.05）.Pharmacists participated in anticoagulation follow-up and educated patients on anticoagulation.After 3 months,the anticoagulation awareness of the three groups increased（P<0.05）,and the adherence to the medication in the edoxaban and dabigatran groups was improved compared with when they were enrolled（P<0.05）.Conclusions:1.Patients with atrial fibrillation included in the first part of this study are undertreated with anticoagulant therapy.2.Patients with atrial fibrillation at high risk of stroke or lacunar infarction tend to be treated with anticoagulant therapy.Patients with an increased risk of bleeding or coronary heart disease tend to choose antiplatelet drugs;Patients with respiratory failure tend to be treated without antithrombotic therapy.3.There is no difference in bleeding events between edoxaban,rivaroxaban and dabigatran.The incidence of rehospitalization events is higher in the edoxaban and rivaroxaban groups than in the dabigatran group,and there is no difference in other adverse events.4.Pharmacists’medication education for patients with atrial fibrillation can improve their anticoagulant awareness and medication compliance of anticoagulants.