Antithrombotic treatment patterns and stroke prevention in patients with atrial fibrillation in TURKEY: inferences from GARFIELD-AF registry

Abstract

Objective: The corner stone of atrial fibrillation therapy includes the prevention of stroke with less adverse effects. The Global Anticoagulant Registry in the FIELD–Atrial Fibrillation (GARFIELD-AF) study provided data to compare treatment strategies in Turkey with other populations and every-day practice of stroke prevention management with complications. Methods: GARFIELD-AF is a large-scale registry that enrolled 52,014 patients in five sequential cohorts at >1.000 centers in 35 countries. This study was initiated to track the evolution of global anticoagulation practice, and to study the impact of NOAC therapy in AF. A total of 756 patients from 17 enrolling sites in Turkey were in cohort 4 and 5. Treatment strategies at diagnosis initiated by CHA 2 DS 2 -VASc score, baseline characteristics of patients, treatment according to stroke and bleeding risk profiles, and INR values were analyzed in cohorts. Additionally, event rates during the first year follow up were evaluated. Results: AF patients in Turkey were mostly seen in young women. Stroke risk according to the CHADS 2 score and CHA 2 DS 2 -VASc score compared with world data. The mean of risk score values, including HAS-BLED score were lower in Turkey than in the world data. The percentage of patients receiving FXa inhibitor with or without an antiplatelet usage was more than the other drug groups. All-cause mortality was higher in Turkey. Different form world data when HAS-BLED score was above 3, the therapy was mostly changed to antiplatelet drugs in Turkey. Conclusion: In addition to deficiencies in available treatment options, patient care and clinical outcomes of patients with AF, the data of GARFIELD-AF provide data from Turkey about therapeutic strategies and best practices.

Oral Anticoagulant Use and Long-Term Follow-Up Results in Patients with Non-valvular Atrial Fibrillation in Turkey AFTER-2 Study

“…In the recent GARFIELD-AF study conducted in Turkey, it has been reported that the frequency of NVAF is higher in women. 3 In addition, it was thought to be associated with obesity, metabolic syndrome, and cardiovascular diseases in Turkish women over 40 years of age. 3 Similarly, the female sex ratio was higher in NVAF patients in the previous AFTER study.…”

“…CHA2DS2-VASc (heart failure, HT, age >75, diabetes, stroke, vascular disease, 65-74 age, and gender category female) risk score classification is widely used in our clinical practice to determine stroke risk. 3 Conventional treatment with vitamin K antagonists (VKA) in patients with non-valvular AF is replaced by non-vitamin K antagonist new oral anticoagulants (NOAC), either direct factor Xa inhibitors or direct thrombin inhibitors. 3 The Atrial Fibrillation: Epidemiological Registry (AFTER) study in Turkey, which is the first multicenter study conducted on AF patients in our country, showed that 40% of non-valvular AF (NVAF) patients were on warfarin treatment, but only 37% of this patients were in the effective international normalized ratio (INR) range; however, the most common reason for inadequate use of warfarin was physician negligence.…”

“… 3 Conventional treatment with vitamin K antagonists (VKA) in patients with non-valvular AF is replaced by non-vitamin K antagonist new oral anticoagulants (NOAC), either direct factor Xa inhibitors or direct thrombin inhibitors. 3 The Atrial Fibrillation: Epidemiological Registry (AFTER) study in Turkey, which is the first multicenter study conducted on AF patients in our country, showed that 40% of non-valvular AF (NVAF) patients were on warfarin treatment, but only 37% of this patients were in the effective international normalized ratio (INR) range; however, the most common reason for inadequate use of warfarin was physician negligence. 4 In addition to the risk of stroke, it is important to control the rate or rhythm in the selected patient group to define the cardiovascular risk profile and to give optimal medical treatment.…”

Current Anticoagulant Usage Patterns and Determinants in Korean Patients with Nonvalvular Atrial Fibrillation

“…The primary reasons for the lack of anticoagulant usage in patients with high stroke risk were physicians' concerns for bleeding events and patient refusal. 19 In our study, the four most important factors favoring non-OAC treatment were ESRD, history of myocardial infarct, history of major bleeding, and cancer. Second, among OAC patients, DOACs were used in 68.8%.…”

Opinions of cardiologists on class II recommendations in current European Society of Cardiology 2018-2020 guidelines: YELLOW BOX

“…New oral anticoagulant (NOAC) therapy was replaced with antiplatelets when the bleeding risk was higher. Allcause mortality was higher in Turkey [13]. In addition RAMSES study showed that the awareness of stroke preventions strategies for NVAF has increased in Turkey and that more than two-thirds of NVAF patients were on OAC therapy.…”