| Objective: This study tried to compare the results of CHADS2 and CHA2DS2-VASc scores in 175 patients with non-valvular atrial fibrillation who were hospitalized in the Second Hospital of Hebei Medical University from April 2014 to December 2014. In addition, to analyze of the current anticoagulant situation in patients with non-valvular atrial fibrillation.Subjects: Patients with non-valvular atrial fibrillation hospitalized in Cardiology Department, the Second Hospital of Hebei medical University from April 2014 to December 2014 were chosen. There were a total of 175 cases, of which the drug treatment group included 138 cases, including 79 cases(57.2%) of male and 59 cases(42.8%) of female. The average age was 67.84±13.71 years old(34~93 years old). The radio frequency catheter ablation group included 37 cases, including 23 cases(62.2%) of male and 14 cases(37.8%) of female. The average age was 62.16±7.66 years old(33~73 years old).Methods: All the cases were divided into drug therapy group(DTG) and radio frequency catheter ablation group(RFCA), and their relevant clinical data, such as gender, age, telephone number, ID number, hospital admission time, whether coexistent with hypertension, diabetes, heart failure, prior stroke or TIA, vascular diseases, liver and kidney functions on admission, bleeding history, control condition of INR, the recent usage of antiplatelet and anticoagulant drugs, whether coexistent with alcohol dependence, the usage of anticoagulant drugs discharged from hospital, etc. were collected to build database in Excel spreadsheets. The CHADS2 and CHA2DS2-VASc scoring systems were used for evaluating the risk of left atrial thrombus and their differences in the scores and risk stratifications were compared. Educate the patients(HDTG) who were at high risk of stroke(CHA2DS2-VASc≥2) from drug treatment group and the patients undergoing surgery from radio frequency catheter ablation group(RFCA) respectively. Suggest taking Warfarin or new oral anticoagulants for anticoagulation and record the reasons why not to accept anticoagulant drugs. Follow-up was performed after the patients were discharged from hospital for three months by returning visit or telephone interview. The follow-up content included whether taking drugs according to the doctor’s advice, whether monitoring of the international standardization ratio(INR) regularly when taking Warfarin, recent control condition of INR(within 1 week from the follow-up time), bleeding/embolism events(including bleeding gums, petechia and ecchymoses of skin and mucous membrane, gastrointestinal hemorrhage, hemorrhagic stroke, ischemic stroke, etc.).Statistical analysis: Creating a database through the application of SPSS 20.0 software package for statistical analysis. The measurement data were expressed as mean ± standard deviation( x ±s). The count data were expressed as percentage. Data were analyzed by the Wilcoxon Rank Sum Test as it did not obey the law of normal distribution. Chi-square test was adopted in compositions of groups. P<0.05 was considered statistically significant.Results:1 Comparing the results of two stroke risk assessment systems in 175 patients with non-valvular atrial fibrillation, The average score of CHADS2 was 1.61±1.34, CHADS2=0, 36 cases(20.6%), CHADS2=1, 62 cases(20.6%), CHADS2≥2, 77 cases(44.0%). The average score of CHA2DS2-VASc was 2.62±1.79, CHA2DS2-VASc=0, 15 cases(8.6%), CHA2DS2-VASc=1, 44 cases(25.1%), CHA2DS2-VASc≥2, 116 cases(66.3%). The average score of CHA2DS2-VASc was significantly higher than that of CHADS2 in these patients(P<0.001). The proportion of low-risk group was significantly lower(P=0.01) while that of high-risk group significantly higher as stratified by CHA2DS2-VASc scores than by CHADS2 scores(P<0.001).2 There was 102 patients(HDTG) who were at high risk of stroke(CHA2DS2-VASc≥2) from drug treatment group. 25 cases of them took aspirin, 12 cases of them took clopidogrel, 10 cases of them took aspirin and clopidogrel, 34 cases of them took warfarin, 2 cases of them took dabigatran(110mg), the other 19 cases took nothing. The patients taking warfarin had monitored INR values regularly, among whom recent INR<2.0, 6 cases, INR between 2.0~3.0, 23 cases, INR>3.0, 5 cases. Antithrombotic rate was just 35.3%, The ratio to achieve therapeutic INR(2.0~3.0) was 67.6%. The investigation of the reasons why not taking warfarin was as follows: 38 cases for worrying about bleeding risk, 12 cases for combining with unstable angina, 14 cases for inconvenience to monitor of INR, 3 cases for emerging gastrointestinal reaction, 1 case for economic reasons. There was 37 patients from radio frequency catheter ablation group(RFCA). 18 cases of them undergoing surgery took warfarin, 19 cases of them took dabigatran(110mg).The patients taking warfarin had monitored INR values regularly. among whom recent INR<2.0, 4 cases, INR between 2.0~3.0, 13 cases, INR > 3.0, 1 case. Antithrombotic rate was 100.0%, The ratio to achieve therapeutic INR(2.0~3.0) was 72.0%. The investigation of the reasons why not taking warfarin was as follows: 5 cases for Worrying about bleeding risk, 13 cases for Inconvenience to monitor of INR, 1 case for Emerging fundus bleeding. Compared to RFCA group, the antithrombotic rate of HDTG was significantly lower(35.3% vs. 100%, P<0.001), while Dabigatran utilization rate was higher(2.0% vs. 51.4%, P<0.001). However, the differences of Warfarin utilization rate and the ratio to achieve therapeutic INR(2.0~3.0) were not of statistical difference between two groups(P=0.099, P=0.099). Worrying about bleeding risk and inconvenience to monitor of INR were the main factors influencing the standardization therapy of Warfarin.Conclusions:1 In this study, through comparing the results of two stroke risk assessment systems, the average score of CHA2DS2-VASc was significantly higher than that of CHADS2 in these patients. The proportion of low-risk group was significantly lower while that of high-risk group significantly higher as stratified by CHA2DS2-VASc scores than by CHADS2 scores. Under stroke risk assessment system CHA2DS2-VASc, there were more patients who need anticoagulation.2 Through the analysis of anticoagulant therapy in patients with non-valvular atrial fibrillation, antithrombotic rate and the ratio to achieve therapeutic INR had improved after the education of anticoagulation, but there was still a certain gap between the present situation and the guideline for anticoagulation therapy. Worrying about bleeding risk and inconvenience to monitor of INR were the main factors influencing the standardization therapy of Warfarin.3 The high antithrombotic rate in patients after radio frequency catheter ablation was closely related to the application of new oral anticoagulants. In the short term, the efficacy and safety of Dabigatran(110mg) were similar to Warfarin. |
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