Primary Prevention And Follow-up Analysis Of Stroke In Patients With Non Valvular Atrial Fibrillation

Objective: To analyze the clinical data of patients with non-valvular atrial fibrillation,and to follow up the incidence of stroke prevention and endpoint events in 1 year,and to explore the related factors affecting the occurrence of ischemic stroke.Methods : A retrospective analysis method is used in this study.According to the inclusion criteria,950 patients with non valvular atrial fibrillation admitted to Department of Cardiology and neurology department of Sichuan Provincial People’s Hospital from January 1,2015 to September 30,2016 were collected,and all the related clinical data of all patients were collected.All patients were 1 years’ followed up to the use of antithrombotic drugs in stroke prevention.,and recorded the clinical endpoint events during the follow-up period(ischemic stroke,total death and bleeding events).According to the occurrence of ischemic stroke in the study subjects,it was divided into stroke group and non-stroke group,and multivariate logistic regression model was applied to analyze the factors influencing the occurrence of ischemic stroke.Results: 1.the average age of patients with non-valvular atrial fibrillation was 72.5 + 10.3 years old,515 cases(54.2%)in males and 435 in females(45.8%).High blood pressure in the first place,with the disease in 525 patients(55.2%)and followed for heart failure in 323 cases(34.0%),296 cases of coronary heart disease(31.2%),279 cases(29.4%),hyperlipidemia diabetes in 154 patients(16.2%),COPD in 106 patients(11.2%),vascular disease,86 cases(9.1%),smoking in 237 patients(24.9%),alcoholic in 72 patients(7.6%).2.antithrombotic therapy: After 1 years of follow-up,the overall anticoagulant rate decreased from 48.6% to 31.6%.baseline CHA2DS2-VASc score was 0 of the 98 cases,74 cases(75.5%)received antiplatelet therapy,24 cases(24.5%)did not receive antithrombotic treatment,the CHA2DS2-VASc score was 1 of the 137 cases,14 cases(10.2%)received anticoagulant therapy,117 cases(85.4%)received antiplatelet therapy,6 cases(4.4%)did not receive antithrombotic therapy,the CHA2DS2-VASc fraction is more than 2 points in 715 cases,448 cases(62.7%)received anticoagulant therapy,255 cases(35.7%)received antiplatelet therapy,12 cases(1.7%)did not receive antithrombotic therapy,Analysis of the causes of 267 patients without anticoagulant therapy: 159 patients(22.2%)were afraid of bleeding events,108 cases(15.1%)had relative contraindication;1 years of follow-up CHA2DS2-VASc score was 0 of the 92 cases,51 cases(55.4%)received antiplatelet therapy,41 cases(44.6%)did not receive antithrombotic therapy,CHA2DS2-VASc The number of 1 of the 125 cases,11 cases(8.8%)received anticoagulant therapy,79 cases(63.2%)received antiplatelet therapy,35 cases(28%)did not receive antithrombotic therapy,the CHA2DS2-VASc fraction is more than 2 points in 686 cases,274 cases(39.9%)received anticoagulant therapy,178 cases(25.9%)received anti platelet treatment,234 cases(34.2%)did not receive antithrombotic therapy.The specific use of antithrombotic drugs: warfarin,clopidogrel,dual antiplatelet drug use at baseline for the number of 439/950,69/950,81/950,1 years follow-up number were 264/903,26/903 and 14/903,both compared to the apparent decline,239 cases(90.5%)were adhered to INR in 264 cases of warfarin with compliance with the doctor’s order.;dabigatran,aspirin at baseline using the number were 16/950,296/950,1 years follow-up number were 14/903,268/903,compared with slightly decreased;and 7 cases with rivaroxaban remained unchanged.3.follow up results: 950 patients lost 47 visits,and 903 patients were followed up for 1 years: 82 cases died(9.1%),ischemic stroke occurred in 58 cases(6.4%),and bleeding occurred in 47 cases(5.2%).4.analysis of influence factors of ischemic stroke: the univariate analysis showed that age(OR=1.034,95%CI;1.007 ~ 1.087),female(OR=1.215,95%CI;1.067 ~ 1.953),hypertension(OR=1.758,95%CI;1.253 ~ 2.317),COPD(OR=1.349,95%CI;1.062 ~ 1.925),heart failure(OR=2.454,95%CI;1.918 ~ 3.702)is a risk factor of patients valvular atrial fibrillation 1 years ischemic stroke,according to the guidelines for the use of antithrombotic drugs(OR=0.479,95%CI;0.153 ~ 0.947)was the protective factor.Multivariate analysis showed that age(OR=1.041,95%CI,1.003 to 1.092),hypertension(OR=1.715,95%CI,1.142 to 2.396),and compliance with guidelines for the use of antithrombotic drugs(OR=0.508,95%CI,0.149 to 0.952)were independent factors influencing the 1 year ischemic stroke in patients with nonvalvular atrial fibrillation.Conclusion: 1.Hypertension is the most common disease in patients with nonvalvular atrial fibrillation,followed by heart failure,coronary heart disease,hyperlipidemia,diabetes,COPD and vascular diseases.2.The rate of anticoagulant treatment in patients with non valvular atrial fibrillation is higher in hospital than in the past.The main reason for the refusal of anticoagulant therapy is to worry about bleeding,most patients can not follow the guidelines for taking antithrombotic drugs,especially taking warfarin patients.3.The incidence of adverse events in patients with nonvalvular atrial fibrillation during follow-up for 1 years is still high,including the all-cause mortality rate is 9.1%,the incidence of ischemic stroke is 6.4%,and the incidence of bleeding events is 5.2%.4.the possibility of ischemic stroke is higher in older patients with hypertension and non valvular atrial fibrillation.The use of antithrombotic drugs in compliance with guidelines can effectively reduce the incidence of ischemic stroke.