Clinical Outcomes of AF Patients with Non-Rheumatic Valvular Heart Disease in Thailand
Keywords:
non-rheumatic valvular heart disease, atrial fibrillation, anticoagulant, stroke, bleeding, nonvalvular atrial fibrillationAbstract
Background : Nonvalvular atrial fibrillation (NVAF) is the most common causes of atrial fibrillation (AF) in clinical practice. Many studies have demonstrated the oral anticoagulant drugs can reduce the risk of thromboembolism, but until now, there have had no clinical outcome trials including anticoagulant drugs in the patients with AF with nonrheumatic valvular heart disease (NRVHD).
Objective : This trial was conducted to determine the clinical outcomes of AF patients with NRVHD compared with NVAF
Methods : This study was a retrospective observational study in patients with AF in Central Chest Institute of Thailand between January 2015 to January 2017. Those were divided into AF patients with NRVHD and patients with NVAF. The primary outcome was the ischemic stroke and secondary outcomes were intracranial hemorrahge, the gastrointestinal bleeding (GIB) or all-cause mortality. The primary and secondary outcomes in this study were analyzed with chi-square test.
Results : A total of 146 AF patients were recruited. There were 40 AF patients in the NRVHD group and 106 patients in the NVAF group .There was ischemic stroke in 3 patients (7.50%) in the NRVHD group and in 10 patients (9.40%) in the NVAF group (RR 0.79: 95% CI, 0.23 to 2.74; p = 0.71). No patient in the NRVHD group (0%) and 4 patients (3.77%) in the NVAF group had the intracranial hemorrhage (RR, 0; p = 0.21). There was gastrointestinal bleeding GIB in 4 patients (10%) in the NRVHD group and 2 patients (1.89%) in the NVAF group (RR 5.3; 95% CI, 1.00 to 27.81; p = 0.02). Eight patients (20.51%) in the NRVHD group and 4 patients (3.77%) in the NVAF group died (RR 5.43; 95% CI, 1.73 to 17.04; p < 0.01).
Conclusions : AF patients with NRVHD had more GIB and death than those with NVAF. The oral anticoagulant drugs were appeared to be the prevention of ischemic stroke in the AF patients with NRVHD comparable to the patients with NVAF. However, the increased risk of GI bleeding and death limited its use in these patients.
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