Antithrombotic therapy use in patients with atrial fibrillation before the era of non-vitamin K antagonist oral anticoagulants: the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF) Phase I cohort

Abstract

AimsThe introduction of non-VKA oral anticoagulants (NOACs), which differ from the earlier vitamin K antagonist (VKA) treatments, has changed the approach to stroke prevention in atrial fibrillation (AF). GLORIA-AF is a prospective, global registry programme describing the selection of antithrombotic treatment in newly diagnosed AF patients at risk of stroke. It comprises three phases: Phase I, before the introduction of NOACs; Phase II, during the time of the introduction of dabigatran, the first NOAC; and Phase III, once NOACs have been established in clinical practice.Methods and resultsIn Phase I, 1063 patients were eligible from the 1100 enrolled (54.3% male; median age 70 years); patients were from China (67.1%), Europe (EU; 27.4%), and the Middle East (ME; 5.6%). The majority of patients using VKAs had high stroke risk (CHA2DS2-VASc ≥ 2; 86.5%); 13.5% had moderate risk (CHA2DS2-VASc = 1). Vitamin K antagonist use was higher for persistent/permanent AF (47.7%) than that for paroxysmal (23.9%). Most patients in China were treated with antiplatelet agents (53.7%) vs. 27.1% in EU and 28.8% in ME. In China, 25.9% of patients had no antithrombotic therapy, vs. 8.6% in EU and 8.5% in ME.ConclusionPhase I of GLORIA-AF shows that VKAs were mostly used in patients with persistent/permanent (vs. paroxysmal) AF and in those with high stroke risk. Furthermore, there were meaningful geographical differences in the use of VKA therapy in the era before the availability of NOACs, including a much lower use of VKAs in China, where most patients either received antiplatelet agents or no antithrombotic treatment.

Use of oral anticoagulation therapy in the first 3 months after the diagnosis of atrial fibrillation in Israel: A population‐based study

“…Nonetheless, we detected an encouraging steady increase in OAC purchasing over time, by 43%, from 29% to 41.4% in the late period (2014‐2015) within just a few years. Our findings are consistent with data from other registries that show that OAC treatment is still underused in real‐world clinical practice, especially outside Western Europe 21‐23 . Although the European PREFER registry reported OAC therapy use by more than 80% of eligible patients, recent data from the NCDR PINNACLE database showed an OAC prescription rate of about 60% 13,15 .…”

“…Again, these numbers varied substantially among different geographic regions. Even so, there was a steady increase in OAC use as compared with a previous report from the same registry 22,23 . The ESC guidelines for AF treatment encourage OAC treatment in high‐risk AF patients, and the introduction of NOACs that are safer and more comfortable for patients probably contributed to this increase in OAC use.…”

“…The high bleeding risk in our population is expressed by the HAS‐BLED score: around 60% of the patients in this cohort had a score of 3 or more, another factor that may be related to low OAC prescription. In comparison, the GARFIELD AF registry 21 reported that 78% to 92% of their patients had a HAS‐BLED score of less than 3 and in the GLORIA‐AF study, this number was 79% 23 . Finally, we only analyzed the prescription records during the first 3 months after AF diagnosis, and patients who received an OAC at a later date might have been wrongly classified as not treated.…”

Clinical and demographic features of patients with stroke and atrial fibrillation

“…Недостаточный охват пациентов с ФП антикоагулянтной терапией является актуальной проблемой во всем мире. Было проведено 2 крупных наблюдательных исследования, целью которых было изучение назначения ОАК пациентам с ФП -регистры EORP-AF (EURObservational Research Programme Atrial Fibrillation Pilot General Registry) и GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) [42][43][44]. В регистр EORP-AF за период с февраля 2012 г. по март 2013 г. было включено 3049 пациентов с ФП из 9 европейских стран (Бельгия, Дания, Греция, Италия, Нидерланды, Норвегия, Польша, Португалия, Румыния).…”

“…В качестве антитромботической терапии большинству пациентов был назначен аспирин -41,7 %, 3,4 % пациентов принимали другие антиагрегантные препараты, 32,8 % пациентов принимали варфарин, 20,2 % пациентов вообще не получали антитромботическую терапию. Факторами, влияющими на прием ОАК, выступили регион (в Европе назначение ОАК было значительно выше, чем в Китае), радиочастотная аблация и тромбоэмболии периферических сосудов в анамнезе, тип амбулаторного учреждения (в специализированых и университетских клиниках частота назначения варфарина была выше, чем в обычных амбулаториях), заболевания печени и препарат-индуцированные кровотечения (снижали шанс назначения пациентам варфарина), высокий риск по шкале CHA 2 DS 2 -VASc [43].…”