Study On Anticoagulation Status And Related Influencing Factors In Hospitalized Patients With Atrial Fibrillation

Objective:To analyze the anticoagulation status of patients with atrial fibrillation(AF)in our hospital,and to explore the main factors affecting the anticoagulation status.To improve the clinical anticoagulation rate.Methods:Using retrospective case analysis.638 patients who met the diagnostic criteria of AF established by the American Heart Association(AHA)in 2019 and hospitalized in the Jiangxi Provincial People’s Hospital from October 2019 to October 2020 were selected(In case of repeated hospitalization,the data of the first hospitalization were adopted),included VAF 74 cases(11.6%),NVAF 564 cases(88.4%).Basic information、Comorbidity、therapeutic regimen、Report of Holter 、Report of medical imageology 、 Report of laboratory examination 、 Reasons for not taking anticoagulants 、 etc of Patients were recorded.The risk of stroke was assessed by CHA2DS2-VASc score.The risk of bleeding was assessed by HAS-BLED score.The baseline data of patients were analyzed,according to whether the patient has a stroke or not,AF patients were divided into stroke group(n=75)and without stroke group(n=563),the average age、average ventricular rate、BMI、SBP、DBP、LAD、LVEF、FPG、TG、TC、etc of the two groups was compared;Stroke and bleeding risk scores 、 anticoagulation rate of patients with anticoagulation indications and compliance rate of International normalized ratio were analyzed.To explore the main factors affecting the rate of anticoagulant therapy of high-risk stroke patients.Data processing with IBM SPSS23.0 statistical software,P<0.05 indicating the difference was statistically significant.Results:(1)Age median 75(70,79)years old and FPG(5.95±1.15)mmol/L in stroke group were higher than that in without stroke group[73(65,78)years old 、(5.61±0.98)mmol/L](Z=-2.329,t=2.810,P<0.05).LVEF[55(51,59)%]in stroke group was lower than that in without stroke group[57(53,60)%](Z=-2.550,P=0.011);(2)In patients with NVAF,the score median of CHA2DS2-VASc was 3(1,4).Stratification results : Low risk:59 cases(10.5%),Moderate risk:109 cases(19.3%),High risk: 396 cases(70.2%).CHA2DS2-VASc score [4(3,5)] in stroke group was higher than that in without stroke group[3(1,4)](Z=-2.515,P=0.012);(3)The score median of HAS-BLED was 2(1,3),390 cases(61.1%)scored 0-2,248cases(38.9%)scored ≥ 3,There was no significant difference in HAS-BLED score between stroke group and without stroke group(P=0.156);(4)Among 470 patients with clear anticoagulant indications,315 patients(67.0%)took oral anticoagulants,among them,263(66.4%)patients with NVAF took oral anticoagulants[134(33.8%)patients took warfarin,79(20.0%)patients took DABE,and 50(12.6%)patients took rivaroxaban];52(70.3%)patients with VAF took warfarin orally.The anticoagulation rate of stroke group(48.0%)was lower than that of without stroke group(70.6%);(5)The overall compliance rate of INR was33.9%,19(36.5%)patients with VAF met the criterion,44(32.8%)patients with NVAF met the criterion,there was no significant difference between them(χ2=0.23,P=0.632);(6)Logistic regression analysis showed that:The diagnosis was first diagnosed AF or paroxysmal AF(OR=1.733;95%CI:1.153～2.605;P=0.008)、periodic monitoring of INR is inconvenient(OR=1.595;95%CI:1.053～2.418;P=0.028)and patients were worried about bleeding and signed off on anticoagulants(OR=1.542;95%CI :1.027～2.316;P=0.037)significantly affect the low anticoagulation rate of AF patients with anticoagulation indications.Conclusion:(1)The total anticoagulation rate of AF patients with clear anticoagulation indications was 67.0%,Compared with the anticoagulant rate of 56.7% reported by AF Medical Quality Control Center in 2019,there is a certain improvement,but compared with the guideline recommendation,it needs to be improved.(2)The proportion of anticoagulant warfarin was the highest in NVAF patients,it may be related to the low price of warfarin and the high proportion of medical insurance reimbursement.However,the compliance rate of INR was low.(3)The diagnosis was first diagnosed AF or paroxysmal AF、periodic monitoring of INR is inconvenient and patients were worried about bleeding and signed off on anticoagulants significantly affect the low anticoagulation rate of AF patients with anticoagulation indications.