Investigation on antithrombotic therapy of hospitalized patients with coronary heart disease complicated with persistent atrial fibrillation

Abstract

Objective To investigate the anticoagulant and antiplatelet therapy in patients with coronary heart disease (CHD) combined persistent atrial fibrillation, analyze the influencing factors of antithrombotic therapy in patients with coronary heart disease, to improve the rate of standardized therapy percentage in clinical practice. Methods From February 2010 to September 2016 in Shanghai East Hospital, a total of 1 742 patients with non-valvular atrial fibrillation complicated with coronary heart disease were enrolled in this study, there were 384 patients (22.0%) with persistent (including permanent) atrial fibrillation, the collection of patients with general information, diagnosis, merger disease, laboratory tests, discharge medication treatment and other related information. Patients had an indication of using anticoagulant and antiplatelet drugs, the risk of thrombosis was assessed using the CHADS2, CHA2DS2-VASc score, the HAS-BLED score assessed the risk of bleeding and compared anticoagulation and antiplatelet therapy in different groups of patients. Results There were differences in patients with paroxysmal atrial fibrillation and persistent atrial fibrillation (NYHA class Ⅲ to Ⅳ, P<0.001) , and the proportion of heart function Ⅲ to Ⅳ grade in patients with persistent atrial fibrillation was significantly higher than that of paroxysmal atrial fibrillation patients. The prevalence of ischemic stroke was 14.4% (paroxysmal atrial fibrillation group) and 18.9% (persistent atrial fibrillation group, P<0.05) , and hemorrhagic stroke was 1.5% and 1.6%, respectively. There was no statistical difference between the two groups. A total of 209 patients (54.5%) were male patients and 175 (45.6%) were female patients, with an average age of (75.0±9.28) years. A total of 302 (78.6%) patients with CHADS2 score≥2 and an average of (2.7±1.4) and CHA2DS2-VASc score≥2 were 368 (95.8%) with an average of (4.3±1.7) . HAS-BLED score≥3 points in 213 patients (55.5%) , with an average of (3.3±0.5) . Among all the patients, 134 patients (34.9%) had warfarin, 250 patients (65.1%) without warfarin, and 37 (9.6%) did not receive any antithrombotic therapy. There were 309 patients (80.5%) with stable CHD in 384 patients. Among them, 51 patients underwent percutaneous coronary intervention (PCI) in 12 months, 35.7% were in anticoagulant therapy and 35.3% in dual anti-platelet therapy. There were 258 patients without PCI, the proportion of anticoagulant therapy was 38.0%, the ratio of anticoagulant therapy was 10.9%, and the proportion of monoclonal antiplatelet was 39.5%. There were 75 patients diagnosed as acute coronary syndrome (ACS) , 63 patients underwent PCI in hospital this time, only 3 patients treated with triple antithrombotic therapy, 29 patients (46.0%) with dual anti-platelet therapy, 19.1% with anticoagulant therapy, there were 12 patients without PCI, 1 patient received warfarin plus monotherapy antiplatelet (8.3%) , 3 patients (25.0%) with dual anti-platelet therapy, monotherapy antiplatelet treatment in 6 cases (50.0%) . Anticoagulation group, antiplatelet group, triple antithrombotic group and no antithrombotic therapy group compared age, gender, previous cerebrovascular events, hypertension, diabetes, renal insufficiency, gastrointestinal bleeding and other possible influencing factors, the results suggest that senior age (≥80 years old) and gastrointestinal hemorrhage was statistically significant between the four groups (P<0.05) . Conclusion The patients with CHD and persistent atrial fibrillation are high risk of thromboembolism and hemorrhage. The anticoagulation therapy of this group is seriously inadequate, and the anti-platelet therapy is relatively regulated. The main factors affecting the decision-making of the antithrombotic program including age≥80 years and history of gastrointestinal bleeding. Key words: Atrial fibrillation; Coronary artery disease; Anticoagulants