Abstract: Objective To explore the rationality of anticoagulant therapy and compare different oral anticoagulants by evaluating the benefits and risks of anticoagulant therapy for the middle-aged non-valvular atrial fibrillation patients with moderate-risk CHA₂DS₂-VASc score. Methods A total of 1,430 middle-aged males with CHA₂DS₂-VASc score of 1 and females with CHA₂DS₂-VASc score of 2 diagnosed and treated in the Department of Cardiology of Tianjin Chest Hospital during Sep. 2018 and Aug. 2020 were enrolled in this retrospective study. According to whether the patients received anticoagulant therapy and the type of anticoagulants they used, the patients were divided into three groups: the rivaroxaban group(n=476), dabigatran group(n=464), and non-anticoagulant therapy group(n=490). The clinical and follow-up data were analyzed to compare differences in the endpoint outcome indicators after 6-30 month followed-up. Results Multivariate Logistic regression analysis of baseline data showed that the known cardiovascular risk factors(including gender, age, type and duration of atrial fibrillation, HAS-BLED score, medical history and antiplatelet drugs)were excluded as the clinical confounding factors influencing the correlation between anticoagulant therapy and endpoint outcomes(P>0.05). The incidence of the clinical endpoint outcomes in the rivaroxaban group and dabigatran group was lower than that in the non-anticoagulant therapy group(rivaroxaban group: OR=0.400, 95%CI: 0.103-0.717, P<0.001; dabigatran group: OR=0.458, 95%CI: 0.094-0.841, P<0.001); the incidence of drug-caused accumulative bleeding events was higher(rivaroxaban group: OR=3.204, 95%CI: 1.190-5.235, P<0.001; dabigatran group: OR=4.173, 95%CI: 1.864-6.494, P<0.001); the incidence of mild bleeding was higher(rivaroxaban group: OR=2.628, 95%CI: 1.538-3.734, P<0.001; dabigatran group: OR=2.759, 95%CI: 2.005-3.525, P<0.001). There were no statistically significant differences in the incidence of other bleeding events among the three groups(major bleeding: χ2=1.680, P=0.432; minor bleeding: χ2=2.888, P=0.236). Univariate Kaplan-Meier survival analysis showed that there was statistical difference in the cumulative incidence of non-clinical endpoint outcomes among the three groups(χ2=19.216, P<0.001). Conclusion Anticoagulant therapy can improve the net clinical benefits and short-term and long-term prognosis. Rivaroxaban and dabigatran anticoagulant therapy have similar anticoagulant effects. Therefore, non-anticoagulant therapy needs to be chosen carefully.

Key words: Non-valvular atrial fibrillation, Middle-aged, CHA₂DS₂-VASc score, Anticoagulant therapy