Evolution of antithrombotic therapy for patients with atrial fibrillation: The prospective global GLORIA-AF registry program

Abstract

Objective To assess baseline characteristics and antithrombotic treatment (ATT) prescription patterns in patients enrolled in the third phase of the GLORIA-AF Registry Program, evaluate predictors of treatment prescription, and compare results with phase II. Methods GLORIA-AF is a large, global, prospective registry program, enrolling patients with newly diagnosed nonvalvular atrial fibrillation (AF) at risk of stroke. Patients receiving dabigatran were followed for two years in phase II, and all patients were followed for 3 years in phase III. Phase II started when dabigatran became available; phase III started when the characteristics of patients receiving dabigatran became roughly comparable with those receiving vitamin K antagonists (VKAs). Results Between 2014 and 2016, 21,241 patients were enrolled in phase III. In total, 82% of patients were prescribed oral anticoagulation ([OAC]; 59.5% novel/nonvitamin K oral anticoagulants [NOACs], 22.7% VKAs). A further 11% of patients were prescribed antiplatelets without OAC and 7% were prescribed no ATT. A high stroke risk was the main driver of OAC prescription. Factors associated with prescription of VKA over NOAC included type of site, region, physician specialty, and impaired kidney function. Conclusion Over the past few years, data from phase III of GLORIA-AF show that OACs have become the standard treatment option, with most newly diagnosed AF patients prescribed a NOAC. However, in some regions a remarkable proportion of patients remain undertreated. In comparison with phase II, more patients received NOACs in phase III while the prescription of VKA decreased. VKAs were preferred over NOACs in patients with impaired kidney function.

Real world time trends in antithrombotic treatment for newly diagnosed atrial fibrillation in China: reports from the GLORIA-AF Phase III registry

“…The shift in treatment distribution had been largely explained by the approximately 50.0% reduction for no antithrombotic treatments (down from 42.0 to 22.0%). However, the landscape of anticoagulation with OACs for stroke prevention in patients with AF in China remains suboptimal compared with the Asia (61.6%) [ 28 ] and global (82.2%) [ 29 ] GLORIA-AF Phase III populations. The Chinese subgroup in the GLORIA-AF Phase III population was noted to be younger than the overall global GLORIA-AF Phase III population (mean [SD] age 66.8 [11.1] and 70.5 [10.6], respectively) [ 29 ] and with a lower body mass index (BMI; mean [SD] 24.73 [3.4] and 28.6 [6.4], respectively) [ 29 ]; a lower age and BMI has been associated with a lower probability of OAC prescription, especially in Asia [ 30 ].…”

“…However, the landscape of anticoagulation with OACs for stroke prevention in patients with AF in China remains suboptimal compared with the Asia (61.6%) [ 28 ] and global (82.2%) [ 29 ] GLORIA-AF Phase III populations. The Chinese subgroup in the GLORIA-AF Phase III population was noted to be younger than the overall global GLORIA-AF Phase III population (mean [SD] age 66.8 [11.1] and 70.5 [10.6], respectively) [ 29 ] and with a lower body mass index (BMI; mean [SD] 24.73 [3.4] and 28.6 [6.4], respectively) [ 29 ]; a lower age and BMI has been associated with a lower probability of OAC prescription, especially in Asia [ 30 ]. Other international real-world registries such as GARFIELD-AF and EORP-AF have reported that over two-thirds of patients with AF were receiving OACs [ 31 , 32 ], and at least one-third to one-half of all patients with AF were receiving OACs in other registries across the East Asia region [ 33 , 34 ].…”

“…Similar findings with NOACs have been demonstrated in Asian patients with AF [ 40 ], especially a significant reduction with regards to the risk of intracranial bleeding [ 41 , 42 ]. An increase in NOACs from Phase II to Phase III was observed in Chinese patients with AF, yet the proportion of NOAC usage remains lower compared with the global and Asian GLORIA-AF Phase III cohorts (60.3% and 42.7%, respectively) [ 29 , 43 ].…”

“…For patients who received dabigatran, most of the prescriptions in this sub-population analysis is of the lower dose, which is common among Asian patients with AF due to concerns regarding known increased bleeding risk with antithrombotic agents among Asian patients due to smaller body sizes, bleeding tendencies, and lower renal clearance rates [ 29 ]. While low dose dabigatran is available for those at risk of bleeding [ 6 , 45 – 47 ], studies have also demonstrated standard dose NOACs as more effective and safer in Asians versus non-Asians for eligible patients with AF and has been highlighted as such in local guideline [ 10 ].…”

How the Hemostasis Laboratory can Help Clinicians to Manage Patients on Oral Anticoagulants

“…It is estimated that at least 70% of patients with non-valvular atrial fibrillation, who are treated for the prevention of ischemic stroke, or those treated for venous thromboembolism and its recurrence, are currently on DOACs, and only the remaining 30% are treated with VKAs. 4 , 5 However, there are still clinical conditions in which DOACs are not adequate. For example, VKAs are still the drugs of choice in the prevention of thrombosis in patients with mechanical heart valves and for the prevention of thromboembolic events in patients with antiphospholipid syndrome.…”