The Clinical Study Of Different Antithrombotic Therapies In Different Risk Patients With Non-valvular Atrial Fibrillation

BackgroundAtrial fibrillation (AF) is the most common sustained cardiac arrhythmia. According to AF Guideline announced by European Society of Cardiology in2010, AF is diagnosed by Electrocardiogram characterized by atrial lectrical activity loss rules orderly, replaced by rapid disorderly fibrillation wave. Nonvalvular atrial fibrillation is closely related to hypertention,coronary diseases,diabetes,heart failure and so on,but without any structural heart diseases. AF affected about1-2%of the general population and increased with age. The number of male suffered from AF is larger than female.AF increases a series of cardiovascular events such as mortality,stroke, other thromboembolic events, heart failure, hospitalization and left cardiac dysfunction. In patients with nonvalvular AF, the risk of stroke is4-5fold of the general population, and of which,ischemic stroke is considered as the major cause for mortality and morbidity. Therefore, it is important to control the complications of thromboembolism in AF patients.Warfarin and aspirin are the most common used drugs for preventing stroke in AF patients. Patients with CHASD2score≥2are recommended to receive warfarin. To those who are with CHA2SD2-VASc score=1will receive warfarin or aspirin, and patients with CHA2SD2-VASc score of0are recommended to receive aspirin or nothing.However, there are several factors which limit its use for many eligible patients:food and drug interactions, narrow window for a therapeutic benefit, inconvenience of monitoring the international normalized ratio (INR) and dose adjustment, and risk of hemorrhage. The risk of bleeding is affected by the dosage of warfarin and the age of patients. Elder patients are with higher risk of bleeding after the administration of drugs. When patients with HAS-BLED score≥3, it would be cautious for the doctors to administrate anticoagulation therapy.Objectives1、To compare the effectiveness of aspirin and warfarin in different risk of patients with nonval vular AF2、To compare the safety of aspirin and warfarin in different risk of patients with nonvalvular AFMethodsFrom January2012to January2013in heart center of our hospital,121cases were admitted, of which104cases were male,and17cases were female.The cases were randomly assigned into4groups respectively. In control group, there were28cases with28men. In aspirin group, there were31cases with no women. In aspirin combined with clopidogrel group, there were30cases and the number of male and female were22and8respectively.32cases were in warfarin group with23men and9women. The following-up time was6to16months with an average of12±1.1months. The including criteria is:(1) Ttypical electrocardiogram is characterized with atrial lectrical activity loss rules orderly, replaced by rapid disorderly fibrillation wave within24hours after being admitted to hospital, and patients have to be with clinical situation.(2)Excluding valvular AF by Echocardiography. In warfarin group, patients were monitored INR before administration and repeated3times a day. The target value of INR is2.0-3.0. Once the INR value is stable, repeat it every4week. The patients were followed up after1week,1month,3months, and6months. And repeat it every3month after that. The dosage of aspirin is100mg/d without monitoring INR and the follow-up is the same as warfarin group. Observe the incidence of thromboembolism and bleeding in the4groups. Statistical analysis was by SPSS13.0software. Measurement data was caculated by using x2test, and P<0.05shows statistical significance.Results1. There was no statistically significant difference with the onset of4groups of patients in age, gender, and high blood pressure, diabetes, coronary heart disease and other complications;2. Ischemic event in Warfarin group is1case(3.1%); Ischemic events in Aspirin combined with clopidogrel group are6cases(20%),P<0.05; Ischemic events in Aspirin group is1case(3.2%),Ischemic events in Aspirin group is1case(3.6%). P>0.05.3. Bleeding events in Warfarin group are2cases(6.7%);The number of bleeding events in Aspirin combined with clopidogrel group is1.(3.3%), P>0.05; There is2case of bleeding event in Aspirin group(6.5%), In control group there is1case(3.6%),P>0.05.Conclusion1. There is no difference in protecting ischemic events in patients with NVAF (CHA2DS2-VASc score=0) with or without aspirin. And aspirin can increase the risk of bleeding, but of no statistical difference(P>0.05).2. Warfarin is more effective than aspirin combined with clopidogrel therapy in anticoagulation for patients with NVAF(CHA2DS2-VASc score=1)(P<0.05), however, warfarin is associated with higher risk of bleeding(P>0.05).