关键词: 心房颤动, 流行病学, 抗栓治疗, 高龄

Abstract: Background　Nonvalvular atrial fibrillation（AF）is a common clinical arrhythmia disease，and AF-related stroke is one of its commonest complications.Available relevant clinical studies mainly focus on antithrombotic therapies or the achievement of antithrombotic goals in coronary heart disease（CHD）patients with AF，but rarely compare the long-term safety and efficacy of different therapies.Objective　To compare the efficacy，safety and one-year AF-related endpoint events of different antithrombotic therapies in nonvalvular AF patients，regardless of age and by age group.Methods　The included 354 nonvalvular AF inpatients were recruited from Department of Cardiovascular，Guangdong Provincial Hospital of Chinese Medicine from January to October 2018.Information was collected，including gender，age，type of AF（paroxysmal，perpetual，persistent，long-standing persistent），complications（stroke/ transient ischemic attack，heart failure，hypertension，diabetes，CHD，hyperlipidemia），cTnT，CHA2DS2-VASc score，and HAS-BLED score.Also，the incidence of thromboembolic events，hemorrhagic events，all-cause deaths and readmission within one-year follow-up period was obtained.The efficacy and safety were compared between groups treated with non-antithrombotic regimen（42 cases），aspirin（21 cases），clopidogrel（51 cases），dual antiplatelet therapy（25 cases），warfarin（49 cases），dabigatran（89 cases）and rivaroxaban（89 cases）.And these regimens' efficacy and safety were further analyzed based on age group﹝<65 age group（60 cases），65-75 age group（92 cases），>75 age group（202 cases）﹞.Results　The proportion of men in dual antiplatelet therapy group was higher than that in non-antithrombotic regimen group（P<0.05）.The average age of warfarin group was younger than that of clopidogrel group（P<0.05）.Paroxysmal AF prevalence in rivaroxaban group was lower than that in dual antiplatelet therapy group（P<0.05）.CHD prevalence in non-antithrombotic group was lower than that of clopidogrel group or dual antiplatelet therapy group，and so did that in warfarin group（P<0.05）.CHD prevalence in dual antiplatelet therapy group was higher than that of rivaroxaban group or dabigatran group（P<0.05）.The average cTnT level of dual antiplatelet therapy group was higher than that of other five groups（P<0.05）.Clopidogrel group had higher average HAS-BLED score than dabigatran group（P<0.05）.The groups treated with different regimens showed statistically significant differences in the incidence of thromboembolic events within one-year follow-up（χ2=12.404，P=0.054）.They also showed statistically obvious differences in the incidence of bleeding events within one-year follow-up（χ2=14.420，P=0.019）.But they demonstrated similar incidence of all-cause deaths（χ2=9.925，P=0.128）.The readmission rate of patients in three age groups was significantly different（P<0.05）.Conclusion　Early identification of AF and timely antithrombotic therapy are of great significance in preventing thromboembolism.New oral anticoagulants（NOAC）or warfarin may be the first choice for antithrombotic treatment of nonvalvular AF.NOAC is not inferior to warfarin in preventing thrombosis and bleeding，but the risk of gastrointestinal bleeding should be paid attention to.For elderly AF patients，individualized anticoagulant therapy may be more effective.

Key words: Atrial fibrillation, Epidemiology, Antithrombotic therapy, Advanced age