关键词: 心房颤动；非瓣膜性房颤；老年人, 80岁以上；抗凝药；华法林；达比加群酯；利伐沙班

Abstract: Background　The proportion of anticoagulant therapy in elderly patients with nonvalvular atrial fibrillation is generally low.The actual situation of anticoagulation in this population is greatly different from the guideline and there is a lack of clinical evidence in the decision of anticoagulant regimens.Objective　The study aimed to investigate anticoagulant regimen use and prognosis in nonvalvular atrial fibrillation patients aged 80 and over.Methods　516 patients （≥80 years）with an initial diagnosis of nonvalvular atrial fibrillation or with a previous diagnosis but without anticoagulant therapy treated in the Second Affiliated Hospital of Zhejiang Chinese Medical University between September 2016 and September 2018 were selected.An analysis was performed on clinical data obtained via reviewing the electronic medical records in the hospital information system and follow-up data，including gender，age，smoking history，comorbidities 〔hypertension，diabetes，coronary artery disease，cardiomyopathy，heart failure，and chronic obstructive pulmonary disease（COPD）〕，types of atrial fibrillation（persistent，paroxysmal or permanent atrial fibrillation），history of ischemic stroke，history of hemorrhage，estimated glomerular filtration rate（eGFR），CHA2DS2-VASc score，HAS-BLED score，post-discharge anticoagulant regimen（warfarin，rivaroxaban，dabigatran or using no anticoagulant therapy），duration of anticoagulant treatment，use of antiplatelet drugs，adverse reactions（bleeding events，ischemic stroke，hemorrhagic stroke，and all-cause mortality）.The influencing factors of death，ischemic stroke and bleeding events were analyzed using binary Logistic regression.Results　Among the participants，137（26.6%）received anticoagulation therapy，including 21 received oral warfarin（4.1%），67 received oral rivaroxaban（13.0%），and 49 received oral dabigatran（9.5%）；379（73.5%）received non-anticoagulant therapy，including 266 received single antiplatelet agents（51.6%），53 received dual antiplatelet agents（10.3%），and 60 received no antiplatelet agent（11.6%）.Sex ratio，average age，prevalence of comorbidities（hypertension，diabetes，coronary artery disease，cardiomyopathy，heart failure，and COPD），prevalence of having a history of smoking，ischemic stroke or hemorrhage，and average eGFR，CHA2DS2-VASc score，and HAS-BLED score，and hemorrhage（mild，moderate，severe）showed no significant differences among participants used warfarin，rivaroxaban，dabigatran and those used no anticoagulant therapy（P>0.05），but ischemic stroke prevalence and all-cause mortality were significantly different（P<0.05）.There was no significant difference in the duration of anticoagulation treatment between three anticoagulation treatment groups（P>0.05）.Binary Logistic regression analysis showed that CHA2DS2-VASc score and anticoagulant regimen were associated with ischemic stroke（P<0.05）.Anticoagulant regimen was associated with death（P<0.05）.HAS-BLED score was associated with bleeding events（P<0.05）.Conclusion　 The prevalence of anticoagulant therapy was relatively low in this group of elderly patients with nonvalvular atrial fibrillation.Non-anticoagulant therapy（including oral antiplatelet agents）increased the risk of death and ischemic stroke，while warfarin showed similar safety and effectiveness to new oral anticoagulants without increasing the risk of bleeding and death.

Key words: Atrial Fibrillation；Nonvalvular atrial fibrillation；Aged, 80 and over；Anticoagulants；Warfarin；Dabigatran；Rivaroxaban