Prognostic value of AST/ALT ratio combined with APTT regimen in NVAF patients receiving rivaroxaban anticoagulant therapy / 国际生物医学工程杂志

Objective:To investigate the prognostic value of the ratio of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) combined with activated partial thromboplastin time (APTT) in elderly patients with non-valvular atrial fibrillation (NVAF) treated with rivaroxaban.Methods:One hundred and twenty-two elderly patients with NVAF who were anticoagulated with rivaroxaban from June 2020 to June 2021 in the Third Central Hospital of Tianjin were enrolled and divided into four groups based on the median method. The patients in the Q1 group ( n = 32) have low AST/ALT/low APTT. The patients in the Q2 group ( n = 27) have low AST/ALT/high APTT. The patients in the Q3 group ( n = 29) have high AST/ALT/low APTT. The patients in the Q4 group ( n = 34) have high AST/ALT/high APTT. The efficacy endpoint events, and safety endpoint events were analyzed in the four groups, and univariate and multivariate Cox regression analyses were performed for the composite endpoint events. Results:The effectiveness endpoint events were mainly cardiovascular deaths, the number of which in the Q1 to Q4 groups was 0 (0), 1 (3.70%), 4 (13.79%), and 5 (14.71%), respectively. The safety endpoint events were mainly non-major bleeding events, the number of which in the Q1 to Q4 groups was 5 (15.62%), 2 (7.41%), 6 (20.69%), and 5 (14.71%), respectively. Compared to the Q1 group, the Q4 group had an increased risk of composite endpoint events after incorporating traditional risk factor correction ( HR: 3.851, 95% CI: 1.167 to 12.704). Conclusions:AST/ALT ratio combined with APTT can provide risk stratification for distant bleeding and cardiovascular adverse events in elderly NVAF patients treated with rivaroxaban anticoagulation and has some predictive value for their prognosis.

Study on population pharmacokinetics of dabigatran in elderly patients with non-valvular atrial fibrillation / 中国药房

OBJECTIVE To analyze influential factors for dabigatran exposure in elderly patients with non-valvular atrial fibrillation. METHODS The clinical information of 75 elderly patients diagnosed with non-valvular atrial fibrillation was collected from our hospital in Jan. 2019-Jun. 2020. One or two steady-state blood drug concentration samples were collected from each patient. NONMEM 7.2.0 software was used to establish a population pharmacokinetics model of dabigatran； the effects of different covariates on the apparent clearance of dabigatran were investigated， and the final model was verified by goodness of fit and Bootstrap method； NONMEM 7.2.0 software was used to analyze the drug exposure of ordinary elderly patients and elderly patients after taking dabigatran ester in different disease states. RESULTS Totally 122 blood concentration samples of dabigatran were collected. Advanced age， creatinine clearance and history of chronic heart failure were screened out as three significant covariates that influenced the clearance of dabigatran in elderly patients. The exposure of population with advanced age increased by about 50% compared with the general elderly， the exposure of population with history of chronic heart failure increased by nearly 30% compared with population without， and the exposure of population with moderate and severe renal injury increased by about 30% and 80% compared with mild. CONCLUSIONS Advanced age， renal injury and history of chronic heart failure are influential factors for elevated systemic exposure of dabigatran.

Research progress in atrial fibrillation with cerebral small vessel disease / 中南大学学报(医学版)

Non-valvular atrial fibrillation is a common arrhythmia and a major risk factor for cardioembolic stroke. Small cerebral vascular disease is a syndrome of clinical, cognitive, imaging, and pathological manifestations caused by intracranial small vascular lesions. The imaging findings on cranial magnetic resonance usually shows recent subcortical small infarction, vascularised lacunae, white matter hypersignal, perivascular space enlargement, cerebral microhemorrhage, and brain atrophy. It is a major cause of neurological loss and cognitive function decline in the elderly. Current studies suggest that atrial fibrillation may increase the imaging load of cerebral small vessel disease through a series of mechanisms such as microembolization, hypoperfusion, inflammation, endothelial dysfunction, and lymphoid system dysfunction. The imaging of cerebral small vessel disease with atrial fibrillation has a potential relationship with cognitive function decline and is related to the occurrence and prognosis of stroke, even more has a potential role in suggesting the etiology and secondary prevention strategies of ischemic stroke.

A Case of Giant Mobile Left Atrial Thrombus during Dabigatran Therapy / 日本心臓血管外科学会雑誌

Dabigatran is a new/direct oral anticoagulant drug unlike warfarin. It is being increasingly used to prevent thromboembolism in patients with nonvalvular atrial fibrillation. We present the case of a 77-year-old woman with a giant left atrial thrombus in spite of anticoagulation therapy with dabigatran 300 mg/day. She had developed a cerebral infarction 18 months previously and was switched from warfarin to dabigatran. However, magnetic resonance imaging showed multiple new cerebral infarcts, and computed tomography scan and echocardiogram revealed a giant thrombus measuring 37×29 mm in the left atrium. Thrombectomy and left atrial appendage closure were urgently performed. Dabigatran was changed to warfarin again after the operation. She has had no recurrent thromboembolic event since then.

SAMe-TT2R2 score for prediction of suboptimal time in therapeutic range in a Thai population with atrial fibrillation

INTRODUCTION@#International normalised ratio (INR) control is an important factor in patients with non-valvular atrial fibrillation (NVAF) being treated with warfarin. INR control was previously reported to be poorer among Asians compared to Westerners. We aimed to validate the SAMe-TT2R2 score for prediction of suboptimal INR control (defined as time in therapeutic range [TTR] < 65% in the Thai population) and to investigate TTR among Thai NVAF patients being treated with warfarin.@*METHODS@#INR data from patients enrolled in a multicentre NVAF registry was analysed. Clinical and laboratory data was prospectively collected. TTR was calculated using the Rosendaal method. Baseline data was compared between patients with and without suboptimal INR control. Univariate and multivariate analyses were performed to identify variables independently associated with suboptimal INR control.@*RESULTS@#A total of 1,669 patients from 22 centres located across Thailand were included. The average age was 69.1 ± 10.7 years, and 921 (55.2%) were male. The mean TTR was 50.5% ± 27.5%; 1,125 (67.4%) had TTR < 65%. Univariate analysis showed hypertension, diabetes mellitus, heart failure, renal disease and SAMe-TT2R2 score to be significantly different between patients with and without optimal TTR. The SAMe-TT2R2 score was the only factor that remained statistically significant in multivariate analysis. The C-statistic for the SAMe-TT2R2 score in the prediction of suboptimal TTR was 0.54.@*CONCLUSION@#SAMe-TT2R2 score was the only independent predictor of suboptimal TTR in NVAF patients being treated with warfarin. However, due to the low C-statistic, the score may have limited discriminative power.

Pacientes con fibrilación auricular no valvular tratados con antivitamina K o anticoagulantes directos: perfil de paciente y efectos a largo plazo / Patients with non-valvular atrial fibrillation on vitamin k antagonists or direct-acting oral anticoagulants: patients profile and long-term follow up outcomes

Resumen Introducción: La llegada de los anticoagulantes directos (ACD) ha supuesto un cambio en el tratamiento de la fibrilación auricular no valvular (FANV) en los últimos años. Los objetivos de este estudio son determinar el grado de control de la anticoagulación con antivitamina K (AVK) y su posible implicación en efectos cardiovasculares adversos mayores (ECAM) y evaluar las diferencias entre el grupo en tratamiento con AVK respecto del grupo con ACD. Pacientes y métodos: Estudio de cohorte prospectivo que incluyó a pacientes consecutivos diagnosticados con FANV valorados en el Servicio de Cardiología con un seguimiento de 18 meses. Se analizaron diferencias demográficas, clínicas y analíticas entre grupos, incluido el grado de control de la anticoagulación del grupo AVK y su posible relación con ECAM. Resultados: Se incluyó a 273 pacientes: 46.5% tratados con AVK, 42.5% con ACD y 11% sin tratamiento anticoagulante. El control de la anticoagulación con AVK fue del 62.1%, sin diferencias en ECAM en función de control. El grupo ACD presentó menos ECAM que el grupo de AVK (13.4 vs. 4.3%; HR, 0.90; 0.83-0.98; p = 0.01), con una menor mortalidad cardiovascular (0.0 vs. 5.5%; HR, 0.94; 0.90-0.98; p = 0.01) y total (0.9 vs. 12.6%; HR, 0.88; 0.82-0.94; p menor que 0,01), aunque sin diferencias significativas en eventos hemorrágicos (0.9 vs. 4.7%; p = 0.07) ni isquémicos (2.6 vs. 0.8%; p = 0.27). Discusión: Los pacientes con AVK poseen un perfil clínico diferente en comparación con los que reciben ACD. El control de anticoagulación del grupo de AVK fue inadecuado en casi la mitad de los casos. El grupo de AVK presentó más ECAM que el grupo de ACD.

Abstract Introduction: The arrival of direct-acting oral anticoagulants (DOACs) has led to a change in the management of non-valvular atrial fibrillation (NVAF) in recent years. The objectives of this study are to determine the level of therapeutic control of anticoagulation with vitamin K antagonists (VKA) and its possible involvement in major adverse cardiovascular events (MACE) and to evaluate differences between the group on VKA with respect to the group on DOACs. Patients and methods: Prospective cohort study that included consecutive patients diagnosed with NVAF in Cardiology Consultations with a clinical follow-up of 18 months. Demographic, clinical and analytical differences between groups were analyzed, including the level of therapeutic control of anticoagulation on the VKA group and its association with MACE. Results: Overall, 273 patients were included: 46.5% on VKA, 42.5% on DOACs, 11% without antithrombotic treatment. Patients on VKA spent 62.1% of their time within therapeutic range (TTR by the Rosendaal formule). There were no differences in MACE depending on anticoagulation control. The DOACs group presented lesser MACE rate than the VKA group (13.4 vs. 4.3%; 0.90; HR 0.90; 0.83-0.98 p = 0.01) with lower cardiovascular mortality (0.0 vs. 5.5%; HR, 0.94; 0.90-0.98; p = 0.01) and total mortality (0.9 vs. 12.6%; HR, 0.88; 0.82-0.94; p less 0.01) although without significant differences in hemorrhagic (0.9 vs. 4.7 %; p = 0.07), or ischemic events (2.6 vs. 0.8%, p = 0.27). Conclusions: Patients on VKA have a different clinical profile than those who receive DOACs. Patients on VKA have an inadequate control of the anticoagulation in quite the half of the cases. The VKA group presented more MACE than the DOACs group.

Cost-effective analysis of LAAC and oral anticoagulants in the prevention of stroke in patients with atrial fibrillation / 中国实用内科杂志

OBJECTIVE: To study the cost-effectiveness of left atrial appendage occlusion(LAAC), rivaroxaban and warfarin in the prevention of stroke in patients with atrial fibrillation, in order to explore the most appropriate economical medication model. METHODS: A total of 156 NVAF patients treated in the First Affiliated Hospital of Dalian Medical University from July2016 to June 2018 were studied; they were divided into group A(LAAC), group B(rivaroxaban)and group C(warfarin)by random digital method.Markov model was used to analyze the drug economy of three methods to prevent stroke in patients with atrial fibrillation within one year, and sensitivity analysis was conducted to verify the stability of the results. RESULTS: The total cost of treatment in group C was significantly lower than that in the other two groups, while in group A it was significantly higher than in the other two groups, with statistical significance(P<0.05). ICER(A vs. B)was 91242.31 yuan/QALY,ICER(B vs. C)was 96706.25 yuan/QALY, and ICER(A vs. C)was 93323.81 yuan/QALY. So the drug economy of group A was better than that of the other two groups, and group B was better than group C. When the sensitive indicators selected changed, there was still a statistical difference in the total cost among the three groups(P<0.05), which indicated that the results of this study were credible. CONCLUSION: Compared with warfarin and rivaroxaban, LAAC may have more pharmacoeco-nomic effects on preventing stroke in patients with atrial fibrillation, but further studies with large sample sizes and longer follow-up cycles are needed.

Analysis of the risk factors of intracranial hemorrhagic transformation in acute cerebral infarction with non-valvular atrial fibrillation patients within 14-days / 中国神经精神疾病杂志

Objective To investigate the risk factors of intracranial hemorrhagic (ICH) transformation within 14-days in acute cerebral infarction with non-valvular atrial fibrillation (NVAF) patients. Methods CT and/or MRI scans of the head were conducted within 14 days on patients with NVAF acute cerebral infarction who admitted to the Department of Neurology, Huizhou Municipal Central Hospital between January 2015 to March 2018. The baseline scan data were reviewed to determine whether ICH conversion occurred. Comparable risk assessment were based on stratification scores using HAS-BLED, ASPECTS, and pc-ASPECTS. Results There were 150 cases of acute cerebral infarction with NVAF, 126 patients were eligible for the analysis, with an ICH conversion rate of 27.0% (34/126). The following four risk factors were statistically significant among the ICH and non-ICH transformation groups: ①systolic blood pressure (SBP) >160 mmHg or diastolic blood pressure (DBP) >100 mmHg post-cerebral infarction, ②Severe cerebral infarction, progressing stroke, ③ASPECTS (pc-ASPECTS) score ≤7 points, and ④ HAS-BLED score ≥3 points (P<0.05). Conclusion Approximately 1/3 of NVAF acute cerebral infarction patients experience an ICH transformation within 14 days of their episode. The following indicators are independent risk factors of ICH transformation: SBP >160mmHg or DBP >100mmHg after cerebral infarction, severe cerebral infarction, progressing stroke, ASPECTS (pc-ASPECTS)≤7 points, and HAS-BLED score≥3 points.

Manejo perioperatorio del paciente anticoagulado con fibrilación auricular no valvular / Perioperative management of the anticoagulated patient with non-valvular atrial fibrillation

Resumen: La fibrilación auricular (FA) aumenta el riesgo de accidente cerebrovascular (ACV) y tromboembolia (TE) sistémica, por lo que resulta fundamental prevenir esta temible complicación a través del tratamiento anticoagulante. Al uso habitual de warfarina se agregaron en los últimos años los anticoagulantes orales directos (ACOD). Frente a una intervención, o procedimiento invasivo es necesario evaluar el riesgo embólico y el de sangrado para definir el manejo más adecuado de estos fármacos. En el presente artículo se proponen recomendaciones para el tratamiento anticoagulante periprocedimiento en la fibrilación auricular no valvular basadas en el consenso de expertos del American College of Cardiology.

Summary: Atrial fibrillation increases the risk of stroke and systemic embolism, so it is important to prevent this terrible complication with anticoagulant therapy. To the usual use of warfarin were added in recent years, direct anticoagulants. In front of an invasive procedure, it is necessary to evaluate embolism and bleeding risks to define the most appropriate management of these drugs. In the present article, recommendations based in expert consensus of American College of Cardiology are proposed, to periprocedural anticoagulation treatment in non-valvular atrial fibrillation.

Comparison of Anticoagulant Efficacy and Safety of Dabigatran Etexilate and Warfarin in the Treatment of Non-valvular Atrial Fibrillation / 中国药房

OBJECTIVE:To compare anticoagulant efficacy and safety of dabigatran etexilate and warfarin in the treatment of non-valvular atrial fibrillation(NVAF). METHODS:In retrospective analysis,360 NVAF patients were divided into control group (180 cases)and observation group(180 cases)according to therapy plan. Control group was given Warfarin sodium tablet with ini-tial dose of 2.5 mg orally,once a day,adjusted dosage according to INR. Observation group was given Dabigatran etexilate cap-sule 150 mg with warm water,twice a day,during or after meal. The levels of ALT,AST and INR,the occurrence of ADR were observed in 2 groups before treatment and 1,3 month after treatment. RESULTS:There was no statistical significance in the levels of ALT or AST between 2 groups before and after treatment (P>0.05). Before treatment,there was no statistical significance in INR between 2 groups (P>0.05),1,3 months after treatment,INR in control group was significantly higher than before treat-ment,with statistical significance(P<0.05);there was no statistical significance in the INR of observation group before and after treatment(P>0.05);but INR of 2 groups ranged were in normal range. There was no statistical significance in the incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:Anticoagnlant efficacy of dabigatran etexilate is significantly better than war-farin for NVAF. Both have similar safety.

Investigation and Analysis of the Anticoagulant Therapy for Patients with Non-valvular Atrial Fibrillation in Our Hospital / 中国药房

OBJECTIVE:To investigate the current situation of anticoagulant therapy for patients with non-valvular atrial fibril-lation,and to provide reference for standardized anticoagulant therapy. METHODS:A total of 1056 patients with non-valvular atri-al fibrillation were collected from our hospital during Jul. 2015-Jun. 2016. According to 2012 European Society of Cardiology Guide-lines for the Management of Atrial Fibrillation,the risks of thrombosis and hemorrhage were evaluated,and the standardized anti-coagulant therapy was also evaluated. RESULTS:Among 1056 patients with non-valvular atrial fibrillation,the number of patients with thrombosis risk score ≥1 was 1028,accounting for 97.3%. 763 patients received antithrombosis therapy,and only 139 pa-tients were given warfarin anticoagulant therapy. The international normalized ratio(INR)of prothrombin time in just 30.9% of pa-tients receiving warfarin was in line with the standard before discharge. CONCLUSIONS:The anticoagulant therapy for patients with non-valvular atrial fibrillation is still not optimistic,and effective measure should be adopted to improve the standardization of anticoagulant therapy in the patients with atrial fibrillation.

Analysis on IL-6-174G/C and-572C/G site gene polymorphism and non-valvular atrial fibrillation population in Xinjiang and national differences / 重庆医学

Objective To investigate the relationship between IL-6-174C/G and-572C/G site gene polymorphism with nonvalvular atrial fibrillation(NVAF) as well as the national differences of interleukin-gene polymorphism between Kazak and Han nationality in Xinjiang region.Methods Seventy-nine Kazak patients of NVAF(Kazak NVAF group),78 Han patients with NVFA (Han NVAF group),75 Han cases of non-AF and 79 Kazak cases of non-AF were selected in Xinjiang region.The venous bloods were collected from extracting DNA.IL-6 gene-174G/C and-572C/G polymorphism in various groups were analyzed by adopting the PCR-RFLP technique.Results The allele frequency of IL-6-572G/C site G in the NVAF group was significantly higher than that in the control group(x2 =4.076,P＜0.05).The allele frequency of IL-6 gene-572 G/C site G had statistical difference between the NVAF group and the control group(OR=1.519,95 ％CI:I.087-2.122,P＜0.05),but the distribution difference between the Han and Kazak control groups had no statistical significance(P＞0.05);the advanced age ≥75 years old)(OR=6.468,95 ％CI:2.427-17.240) and left atrial dimension(OR =1.053,95 ％ CI:1.022-1.085) were the independent factors of AF occurrence;the left ventricular ejection fraction was a protective factor for preventing AF occurrence.The allele frequency of IL-6 gene 174G/C site C and G had no statistical difference among various groups(P＞0.05).Conclusion The allele of IL-6-572 G/C site G is a risk factor of genetic predisposition in NVAF.IL-6-174G/C site gene polymorphism has no relation with the susceptibility of AF.

The clinical characteristic analysis of ischemic stroke in patients with non-valvular atrial fibrillation / 天津医药

Objective To analyze the clinical and laboratory characteristics of the ischemic stroke in patients with non-valvular atrial fibrillation (AF), and to provide evidence for the prevention of ischemic stroke. Methods A total of 198 patients with ischemic stroke were chosen and divided into two groups:with AF (71 patients)/and without AF (127 patients) groups. Clinical data and biochemical markers were collected and compared in two groups. CHADS2 and CHA2DS2-VASc score systems were used to determine the risk levels in patients with AF. Finally, related risk factors of ischemic stroke with AF were determined and analyzed. Results The values of age, length of hospital stay, the hypertention history, heart rate and plasma homocysteine (Hcy) were significantly higher in the with-AF group than those in the without-AF group ( P <0.05). The levels of total cholesterol (TC), triglyceride (TG) and very low density lipoprotein cholesterol (VLDL-C) were sig?nificantly lower in the with-AF group than those of the without-AF group (P<0.05). CHA2DS2-VASc scores reached to the moderate-to-high risk level in the with-AF group. Multiple-factor logistic regression analysis showed that age and heart rate were the independent risk factors of the ischemic stroke in patients with non-valvular AF. ROC analysis indicated that age (AUC=0.761, cut-off point=72.50 years old) and heart rate (AUC=0.612, cut-off point=76.50 bit/min) had predictive and di?agnostic value for the ischemic stroke in patients with non-valvular AF. The age of these patients had the best sensitivity (70.4%) and specifity (71.1%), and the cut-off point of which was 72.50 years old. Conclusion The characteristics of isch?emic stroke in patients with non-valvular AF includes older age, faster heart rate, higher CHA2DS2-VASc scores and higher Hcy level.

Practice Preferences on Dabigatran and Rivaroxaban for Stroke Prevention in Patients with Non-valvular Atrial Fibrillation

OBJECTIVE: Prescription rate of dabigatran and rivaroxaban, which are the direct oral anticoagulants (DOAC), has increased. We have analyzed the prescription trend and medication use of dabigatran and rivaroxaban in patients with non-valvular atrial fibrillation (NVAF). METHODS: It was retrospectively studied from September 2012 to April 2014 using the electronic medical records and the progress notes. Patients with NVAF (n=424) were evaluated on the medication use, prescribing preferences, adverse drug reactions (ADRs) and the availability of prescription reimbursement of dabigatran (n=210) and rivaroxaban (n=214). RESULTS: Dabigatran was prescribed higher than rivaroxaban (23.3% versus 7.5%, p<0.001) in the neurology department, but rivaroxaban was prescribed higher compared to dabigatran in the cardiology department (87.4% versus 74.3%, p<0.001). Dabigatran was prescribed more than rivaroxaban in high risk patients with CHADS2 score ≥ 3 (44.3% versus 31.3%, p=0.006). Dabigatran patients seemed to have more ADRs than patients with rivaroxaban (25.2% versus 11.2%, p<0.001), but no serious thrombotic events and bleeding were found. Only 35.6% (n=151) were eligible for prescription reimbursement by the National Health Insurance (NHI). Bridging therapy (86, 31.5%) and direct-current cardioversion (57, 20.2%) were main reasons of ineligibility for reimbursement. CONCLUSION: Prescription preferences were present in choosing either dabigatran or rivaroxaban for patients with NVAF. Inpatient protocols and procedures considering patient-factors in NVAF need to be developed.

Use of Novel Oral Anticoagulants Post-cardioversion in Atrial Fibrillation: A Safety Review.

Atrial fibrillation is considered the most common sustained arrhythmia worldwide, especially in geriatric population and is associated with significant morbidity and mortality. Arterial embolization is the most serious complication of atrial fibrillation. Vitamin K antagonists were the only form of oral anticoagulant medication approved for long-term use since 1940s, till the advent of three novel oral anticoagulants- dabigatran, rivaroxaban and apixaban. The new anticoagulants are more convenient to administer than warfarin. Pivotal trials of these drugs showed that they are not only as effective as warfarin, but also cause less intracranial bleeding. There is data emerging regarding the safety of these agents in the context of cardioversion. The purpose of this review is to examine the current published safety data for the use of novel oral anticoagulants around the time of cardioversion.

Una enfermedad prevenible: el accidente cerebrovascular en la fibrilación auricular no valvular. ¿Qué lugar ocupan los nuevos anticoagulantes orales? / A preventable disease: stroke in non-valvular atrial fibrillation. What is the role of the new oral anticoagulants?

La fibrilación auricular no valvular (FANV) es la arritmia cardíaca sostenida más frecuente. El accidente cerebrovascular (ACV) asociado a la (FANV), es una complicación devastadora, prevenible, con secuelas neurológicas, recurrencias, mortalidad precoz y al año mayor que el (ACV) no asociado a la (FANV). La warfarina demostró en prevención primaria una reducción del riesgo de 64%. El presente trabajo aborda nuevos scores de riesgo de embolia en la (FANV), riesgo de sangrado, y los resultados de 3 trabajos multicéntricos que comparan dabigatran, rivaroxaban y apixaban vs. warfarina en prevención del (ACV) asociado a (FANV). Intenta, de acuerdo a lo anterior, un posicionamiento de los nuevos anticoagulantes orales (NAO) como opción frente a la warfarina. Realiza consideraciones prácticas generales y en situaciones puntuales para el uso de los (NAO).

Non valvular atrial fibrillation (NVAF) is the most common sustained arrhythmia. NVAF-associated stroke is a devastating, preventable condition with neurological sequels, recurrences, early mortality and greater than NVAF-independent stroke annually. Warfarin showed a 64% risk reduction in primary prevention. The paper herein approaches new risk scores for embolism in NVAF, risk for bleeding, and the results of 3 multicentric studies comparing dabigatran, rivaroxaban and apixaban vs. Warfarin in the prevention of NVAF-associated stroke. Based on the above, it is intended to position the new oral anticoagulants (NOA) as a potential option vis à vis warfarin. The authors reach practical considerations, both general and in specific situations for the use of NOAs.

The application of CHA2DS2-VASc score in ischemic stroke patients with non-valvular atrial fibrillation / 中国神经精神疾病杂志

Objective To study the relationship between CHA2DS2-VASc score and intracranial atherosclerosis, Chinese ischemic stroke subclassification (CISS) classification and the early neurological outcomes in ischemic stroke pa-tients with non-valvular atrial fibrillation (NVAF), and to evaluate the clinical value of CHA2DS2-VASc score. Methods The retrospective analysis method was used. The data from 149 cases of ischemic stroke patients with NVAF was retro-spectively analyzed. The clinical data mainly included clinical manifestations, routine lab tests, imaging examinations such as the color-echo doppler, brain CT and/or MRI and angiographic studies of CTA and/or MRA of brain, CHA2DS2-VASc score, the CISS and the National Institutes of Health stroke scale (NIHSS). Results The CHA2DS2-VASc score was significantly higher in patients with intracranial atherosclerosis than those without [(5.13±1.39) vs. (4.14±1.67)] (P<0.05). The occurrence rates of intracranial atherosclerosis were significantly different among different CHA 2DS2-VASc score subgroups (0~1, 2~3, 4~5 and≥6 subgroups) (P<0.05). There were significant differences in CHA2DS2-VASc score among CS+LAA group, CS+LAA+PAD,group CS, group and CS+PAD group (all P<0.05). There was statistical difference in CHA2DS2-VASc score between patients with and without improvements (P<0.05). Conclusion The CHA2DS2-VASc score may be associated with concomitant intracranial atherosclerosis of ischemic stroke patients with NVAF which can be used to predict the condition of intracranial atherosclerosis. The CHA2DS2-VASc score is positively correlated with se-verity of ischemic stroke with NVAF which can be used to predict the disease improvements in patient with NVAF.

Study on the correlation between CETP TaqIB,KCNE1 S38G and eNOS T-786C gene polymorphisms for predisposition and non-valvular atrial fibrillation / 中华流行病学杂志

Objective To study whether CETP TaqIB,KCNE1 S38G and eNOS T-786C genetic polymorphisms are associated with non-valvular atrial fibrillation in the Han population from Zhejiang province.Methods Polymerase chain reaction restriction fragment length polymorphism assay was used to detect the distribution of alleles and genotypes of CETP TaqIB,KCNE1 S38G and eNOS T-786C in 147 patients with non-valvular atrial fibrillation and in 147 subjects as controls in Han population of Zhejiang province.Results (1)The frequency of CETP B1 allele in NVAF patients was higher than that of the control group and showing a statistically significant difference(OR=1.763,95%CI:1.247-2.492.P=0.002). (2) Results from logistic regression analysis revealed that: after adjustment of confounding variables such as sex,age,smoking,hypertension and body mass index,data from the binary logistic analysis showed a statistically significant difference in CETP TaqIB genetic polymorphism between Patients and controls.(3)From multifactor dimensionality reduction analysis,results showed an interaction of CETP TaqIB,KCNE1 S38G and eNOS T-786C genetic polymorphisms.Odds ratio of the three simultaneously existing genetic polymorphisms was 1.849 times more than CETP TaqIB alone.Conclusion CETP BI allele was an independent risk factor for predisposition to non- valvular atrial fibrillation.These findings suggested that the simultaneous existence of CETP B1,KCNE1 S38G and eNOS T-786C allele might be elevated with the predisposition to non-valvular atrial fibrillation in the Han population of Zhejiang province.