Usage of oral anticoagulant and influencing factors in nonvalvular atrial fibrillation: an analysis of 3 984 inpatients

Abstract

Objective To investigate the use of anticoagulant drugs in hospitalized patients with nonvalvular atrial fibrillation (NVAF), and to explore the relevant factors that affect the efficacy of drug treatment in the patients. Methods A retrospective analysis was conducted on the NVAF inpatients admitted in our department from January 1, 2016 to December 31, 2019. Their clinical characteristics and usage of oral anticoagulants were collected and analyzed. According to the stratification of stroke risk, the patients with CHA2DS2-VASc score≥2 were selected to explore their use of anticoagulants. Logistic regression analysis was used to analyze the influencing factors of anticoagulation therapy. Results Among the 3 984 patients included, there were 2 438 (61.2%) anticoagulant patients, including 247 (39.0%), 316 (42.6%), 736 (65.3%), and 1 139 (76.9%) patients, respectively during the year of 2016 to 2019. The number of patients with CHA2DS2-VASc≥2 was 3 418, and 60.4% (2 065) of them took anticoagulants. Logistic regression analysis showed that age≥75 years (OR=0.494), vascular diseases (OR=0.838), acute coronary syndrome (ACS) (OR=0.583), history of percutaneous coronary intervention (PCI) (OR=0.651), bleeding history (OR=0.436), renal insufficiency (OR=0.625), drugs (OR=0.634), and before price reduction of new oral anticoagulants (NOAC) (OR=0.22) were influencing factors to reduce the rate of anticoagulation treatment (P < 0.05); While, atrial fibrillation ablation (OR=2.093) and stroke history (OR=1.351) were influencing factors to increase the treatment rate (P < 0.05). Conclusion Though the rate of anticoagulation treatment for NVAF patients is increasing year by year, but it is still lower than that in the European and American countries. Bleeding history, combined use of antiplatelet drugs, renal insufficiency, before NOAC price reduction, age ≥75 years, accompanied with vascular diseases, ACS, and post-PCI are influencing factors to reduce the rate, and atrial fibrillation ablation and stroke history are factors increasing the rate of anticoagulant treatment.

Keywords

• non-valvular atrial fibrillation
• anticoagulant treatment rate
• warfarin
• new oral anticoagulants
• influencing factors