Evolving antithrombotic treatment patterns for patients with newly diagnosed atrial fibrillation

Abstract

ObjectiveWe studied evolving antithrombotic therapy patterns in patients with newly diagnosed non-valvular atrial fibrillation (AF) and ≥1 additional stroke risk factor between 2010 and 2015.Methods39 670 patients were prospectively enrolled in four sequential cohorts in the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF): cohort C1 (2010–2011), n=5500; C2 (2011–2013), n=11 662; C3 (2013–2014), n=11 462; C4 (2014–2015), n=11 046. Baseline characteristics and antithrombotic therapy initiated at diagnosis were analysed by cohort.ResultsBaseline characteristics were similar across cohorts. Median CHA2DS2-VASc (cardiac failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65–74 and sex category (female)) score was 3 in all four cohorts. From C1 to C4, the proportion of patients on anticoagulant (AC) therapy increased by almost 15% (C1 57.4%; C4 71.1%). Use of vitamin K antagonist (VKA)±antiplatelet (AP) (C1 53.2%; C4 34.0%) and AP monotherapy (C1 30.2%; C4 16.6%) declined, while use of non-VKA oral ACs (NOACs)±AP increased (C1 4.2%; C4 37.0%). Most CHA2DS2-VASc ≥2 patients received AC, and this proportion increased over time, largely driven by NOAC prescribing. NOACs were more frequently prescribed than VKAs in men, the elderly, patients of Asian ethnicity, those with dementia, or those using non-steroidal anti-inflammatory drugs, and current smokers. VKA use was more common in patients with cardiac, vascular, or renal comorbidities.ConclusionsSince NOACs were introduced, there has been an increase in newly diagnosed patients with AF at risk of stroke receiving guideline-recommended therapy, predominantly driven by increased use of NOACs and reduced use of VKA±AP or AP alone.Trial registration numberNCT01090362; Pre-results.

Oral anticoagulant therapy for older patients with atrial fibrillation: a review of current evidence

“…The evidence on safety and the lack of need for routine coagulation monitoring, along with some evidence that DOACs may have greater psychological tolerability in elderly patients [105] make DOACs particularly attractive, and should hopefully widen the treatment options also for frail individuals, thereby allowing a greater number of patients to be treated according to current recommendations. In accord with these considerations, since DOACs were approved, it has been reported an increased number of newly diagnosed AF patients -including older subjects -properly treated with OAT; this was predominantly driven by an increased use of DOACs and reduced use of VKAs and/or antiplatelet therapy [106].…”

Clinical and Economical Comparison of Rivaroxaban and Apixaban Use in Patients With Non-Valvular Atrial Fibrillation

“…При этом в структуре назначений НОАК ингибиторы Xa фактора преобладают над прямыми ингибиторами тромбина вне зависимости от исходного риска крово-течений, оценивавшегося по шкале HAS-BLED, причем разрыв между ними проспективно увеличивается с тече-нием времени. Так, если на старте наблюдения (2009-2011 гг) процент назначений ингибиторов Xa состав-лял около 2%, а прямых ингибиторов тромбина -1,1%, то к моменту последнего опубликованного анализа, включившего данные за 2014-2015 гг, соотношение со-ставило уже приблизительно 30% к 8% в пользу ин-гибиторов Xa фактора [19].…”

“…В связи с этим нами проведена фармакоэкономи-ческая оценка эффективности применения риварок-сабана и апиксабана -двух современных НОАК, отно-сящихся к одному фармакологическому классу (прямые ингибиторы Xa фактора) и являющихся, согласно ми-ровой практике, наиболее часто назначаемыми НОАК у пациентов с неклапанной ФП [19].…”

Características basales, manejo de terapias antitrombóticas y pronóstico de pacientes chilenos con FA no valvular. Lecciones del Registro GARFIELD AF en Chile

“…En todo caso estos resultados debieran constituir un llamado de alerta sobre la necesidad de mejorar políticas públicas para un mejor control de la terapia anticoagulante con AVK. En nuestro medio el porcentaje de empleo de nuevos anticoagulantes directos se ha mantenido alrededor de 10% en los 4 años de participación en Garfield AF, a diferencia de lo observado en la gran mayoría de países que participan en este registro, donde se observa un incremento progresivo de estos fármacos cuyo perfil de seguridad es mayor 27,28 .…”