Use of antithrombotics in atrial fibrillation in Africa, Europe, Asia and South America: Insights from the International RealiseAF Survey

Gamra, Habib; Murı́n, J; Chiang, Chern‐En; Naditch-Brûlé, Lisa; Brette, Sandrine; Steg, Philippe Gabriel; investigators, RealiseAF

doi:10.1016/j.acvd.2014.01.001

Cited by 83 publications

(53 citation statements)

References 39 publications

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“…Specific data on associated comorbidities from surveys and cohort studies of AF from various Asian countries, compared to non-Asians are summarized in Table 1 [3,[9][10][11][12][13][14][15]. The average age and proportion of females in Asians and non-Asians were broadly similar.…”

Section: Epidemiology -A Brief Overviewmentioning

confidence: 99%

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Non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in Asian patients with atrial fibrillation: Time for a reappraisal

Lip

Wang

Chiang

2015

International Journal of Cardiology

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144

118

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Non-vitamin K antagonist oral anticoagulants (NOACs) have changed the landscape for stroke prevention in atrial fibrillation (AF). Given the huge burden of AF in Asians, more attention to stroke prevention is clearly needed. Aiming to provide an overview and reappraisal of stroke prevention in Asians with AF, we searched MEDLINE for information on NOACs in Asians. In addition, abstracts from national and international cardiovascular meetings were studied to identify unpublished studies. In the 4 recent Phase 3 trials comparing NOACs to warfarin, a consistent pattern is evident. For efficacy endpoints in the comparison of NOACs vs warfarin, a significant reduction in stroke/systemic embolization was seen for dabigatran 150mg [HR 0.45 (0.28-0.72)], with non-significant trends seen for lower stroke/systemic embolization with other NOACs, except edoxaban 30mg. A similar pattern was seen for ischaemic stroke, with a significant reduction for dabigatran 150mg [HR 0.55 (0.32-0.950]. For haemorrhagic stroke, all NOAC regimes, except rivaroxaban 20mg, had significantly lower hazard ratios. No evidence of increased myocardial infarction was found for NOACs. All-cause mortality was significantly lowered amongst Asian patients on edoxaban 60mg compared to warfarin [HR 0.63 (0.40-0.98)] with non-significant trends to lower mortality with dabigatran 150mg, rivaroxaban and edoxaban 30mg. For safety endpoints, all the NOAC regimes, except rivaroxaban 20mg, significantly reduced major bleeding and 'all bleeding' events. Intracranial haemorrhage was consistently lowered by all NOACs. None of NOACs increased gastrointestinal bleeding. These information suggested that NOACs should be preferentially indicated for stroke prevention in Asians with AF.

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Section: Epidemiology -A Brief Overviewmentioning

confidence: 99%

“…Non-Asians J-Rhythm [9] HK [3] RECORDAF AP [10] REALISEAF Asia [11] RELY AF Southeast Asia [12] ORBIT AF [13] Euro Heart Survey [14] RECORDAF [15] REALISEAF Europe [11] RELY AF West Europe [12] CHF (%) 34 for example, the annual incidence of ICH in patients taking aspirin and warfarin was 0.77% per year and 0.80% per year, respectively [3].…”

Section: Asiansmentioning

confidence: 99%

Non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in Asian patients with atrial fibrillation: Time for a reappraisal

Lip

Wang

Chiang

2015

International Journal of Cardiology

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144

118

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“…However, despite recommendations, OACs are still underused in clinical practice (Gamra et al, 2014;Ogilvie, Newton, Welner, Cowell, & Lip, 2010), with nearly the half of eligible patients who do not actually receive antithrombotic prophylaxis (Pugh, Pugh, & Mead, 2011) or receive drugs which are less effective than OAC, such as antiplatelets (APT) (Lip et al, 2014;Plichart et al, 2013). Although several conditions have been reported to be associated with under-prescription of OAC (Bahri et al, 2015;Wang et al, 2014), reasons of underuse are not completely known; it could be hypothesized that, beyond OAC eligibility, other variables, such as socio-demographic context, co-occurrence of chronic diseases and perception of patients' non-adherence to OAC may contribute to persistent under-use of OAC.…”

Section: Introductionmentioning

confidence: 99%

The role of comprehensive geriatric assessment and functional status in evaluating the patterns of antithrombotic use among older people with atrial fibrillation

Mazzone

Lucenti

et al. 2016

Archives of Gerontology and Geriatrics

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“…22,23 As a result, a rising number of stroke deaths have been recorded in the region, which is estimated to increase over the next few decades. 24 …”

Section: Methodsmentioning

confidence: 99%

Stroke Prevention in Atrial Fibrillation: Focus on Latin America

Massaro¹,

Lip²

2016

Arquivos Brasileiros De Cardiologia

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Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, with an estimated prevalence of 1-2% in North America and Europe. The increased prevalence of AF in Latin America is associated with an ageing general population, along with poor control of key risk factors, including hypertension. As a result, stroke prevalence and associated mortality have increased dramatically in the region. Therefore, the need for effective anticoagulation strategies in Latin America is clear. The aim of this review is to provide a contemporary overview of anticoagulants for stroke prevention.The use of vitamin K antagonists (VKAs, eg, warfarin) and aspirin in the prevention of stroke in patients with AF in Latin America remains common, although around one fifth of all AF patients receive no anticoagulation. Warfarin use is complicated by a lack of access to effective monitoring services coupled with an unpredictable pharmacokinetic profile. The overuse of aspirin is associated with significant bleeding risks and reduced efficacy for stroke prevention in this patient group. The non-VKA oral anticoagulants (NOACbs) represent a potential means of overcoming many limitations associated with VKA and aspirin use, including a reduction in the need for monitoring and a reduced risk of hemorrhagic events.The ultimate decision of which anticoagulant drug to utilize in AF patients depends on a multitude of factors. More research is needed to appreciate the impact of these factors in the Latin American population and thereby reduce the burden of AF-associated stroke in this region.

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Use of antithrombotics in atrial fibrillation in Africa, Europe, Asia and South America: Insights from the International RealiseAF Survey

Cited by 83 publications

References 39 publications

Non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in Asian patients with atrial fibrillation: Time for a reappraisal

Non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in Asian patients with atrial fibrillation: Time for a reappraisal

The role of comprehensive geriatric assessment and functional status in evaluating the patterns of antithrombotic use among older people with atrial fibrillation

Stroke Prevention in Atrial Fibrillation: Focus on Latin America

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