Objectives To investigate the current status of antithrombotic treatment in elderly patients with nonvalvular atrial fibrillation. The general feature were recorded and risk factors of stroke thromboembolism were estimated in order to provide data for clinical treatment.
Methods The total of 428 elderly inpatients and outpatients with nonvalvular atrial fibrillation in 8 grade III general hospitals in Beijing were chosen as research object during November 2011 to February 2013. Observed hospital antithrombotic treatment, and analysis of possible factors that affect treatment decisions. Divided into long-term warfarin, long-term antiplatelet group and no antithrombotic group according to long-term drug use.
Results Male and female cases were 249 (58.18%)and 179 (41.82%) respectively. Mean age was (78.45 ± 7.84) years old. Among all these thromboembolism events, 153 cases (93.87%) were stroke Nonrheumatic heart disease AF risk levels were quantified using the CHADS2 index. One point each was given for patients with congestive heart failure, hypertension, advanced age (≥75 years) and diabetes mellitus, and 2 points to those with prior ischaemic stroke and transient ischaemic attack. Patients with a CHADS2 score of 0 were classified as low risk, 1 as moderate risk and 2 or more as high risk. Non-rheumatic heart disease with AF were high risk embolism. 81.78% of the patients were classified into high risk group, 14.02% into moderate risk, and 4.21% into low risk. Among these patients, aspirin was prescribed in 183 patients by physicians, 16 were treated with clopidogrel, warfarin was suggested to 78 patients by physicians, 8 were treated with dabigatran and 76 patients were given nothing antithrombotic therapy. According to stroke risk level, there were 350 patients were suggested to use warfarin and the practical percent of using warfarin was 29.71% (104/350). Previous bleeding events and ege are the possible factors affecting treatment decisions. Of the total patients received warfarin, including monitoring of the international normalised ratio (INR) 73.08% (76/104). The average level of INR was (1.79 ± 0.61). And patient’s INR being between 2.0 and 3.0 was 28 cases, which percentage was 26.92%. And INR being between 1.6 and 2.5 was 35 cases, which percentage was 33.65%.
Conclusions With ages growing, the incidence of thromboembolic complications increasing. The higher CHADS2 score, the higher risk level of thromboembolic events. CHADS2 score has a reliable predictive value about vascular events. Warfarin is underused in elderly patients with NVAF who had indications of anticoagulation. For the eldely patients with NVAF, age, hypertension, heart failure and history of bleeding are the main factors affecting receiving anticoagulant therapy.