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. 2015 Apr 27;10(4):e0125164.
doi: 10.1371/journal.pone.0125164. eCollection 2015.

Use of Anticoagulants and Antiplatelet Agents in Stable Outpatients with Coronary Artery Disease and Atrial Fibrillation. International CLARIFY Registry

Laurent Fauchier  1 , Nicola Greenlaw  2 , Roberto Ferrari  3 , Ian Ford  2 , Kim M Fox  4 , Jean-Claude Tardif  5 , Michal Tendera  6 , Ph Gabriel Steg  7 ; CLARIFY Investigators
Collaborators, Affiliations

Use of Anticoagulants and Antiplatelet Agents in Stable Outpatients with Coronary Artery Disease and Atrial Fibrillation. International CLARIFY Registry

Laurent Fauchier et al. PLoS One. .

Abstract

Background: Few data are available regarding the use of antithrombotic strategies in coronary artery disease patients with atrial fibrillation (AF) in everyday practice. We sought to describe the prevalence of AF and its antithrombotic management in a contemporary population of patients with stable coronary artery disease.

Methods and findings: CLARIFY is an international, prospective, longitudinal registry of outpatients with stable coronary artery disease, defined as prior (≥12 months) myocardial infarction, revascularization procedure, coronary stenosis >50%, or chest pain associated with evidence of myocardial ischemia. Overall, 33,428 patients were screened, of whom 32,954 had data available for analysis at baseline; of these 2,229 (6.7%) had a history of AF. Median (interquartile range) CHA2DS2-VASc score was 4 (3, 5). Oral anticoagulation alone was used in 25.7%, antiplatelet therapy alone in 52.8% (single 41.8%, dual 11.0%), and both in 21.5%. OAC use was independently associated with permanent AF (p<0.001), CHA2DS2-VASc score (p=0.006), pacemaker (p<0.001), stroke (p=0.04), absence of angina (p=0.004), decreased left ventricular ejection fraction (p<0.001), increased waist circumference (p=0.005), and longer history of coronary artery disease (p=0.008). History of percutaneous coronary intervention (p=0.004) and no/partial reimbursement for cardiovascular medication (p=0.01, p<0.001, respectively) were associated with reduced oral anticoagulant use.

Conclusions: In this contemporary cohort of patients with stable coronary artery disease and AF, most of whom are theoretical candidates for anticoagulation, oral anticoagulants were used in only 47.2%. Half of the patients received antiplatelet therapy alone and one-fifth received both antiplatelets and oral anticoagulants. Efforts are needed to improve adherence to guidelines in these patients.

Trial registration: ISRCTN registry of clinical trials: ISRCTN43070564.

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Conflict of interest statement

Competing Interests: This study was funded via research grants from Servier. Editorial support was provided by Sophie Rushton-Smith, PhD (MedLink Healthcare Communications). Dr. Fauchier reports consultancy fees/honoraria from Bayer, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb-Pfizer alliance, Medtronic, Novartis, Sanofi, and Servier. Ms Greenlaw reports no relationships. Dr. Ferrari reports Speaker’s bureau for Servier, Roche, Boehringer Ingelheim; research grants from Servier, Boehringer Ingelheim and Roche; and advisory board for Servier, Bayer, Roche and Boehringer Ingelheim. Dr Ford reports research grants, honoraria for committee membership, and support for conference attendance from Servier. Dr. Fox reports fees, honoraria, and research grants from Servier. Dr. Tarif reports research grants and honoraria from Servier. Dr. Tendera reports fees, honoraria, and research grants from Amgen, Bayer, Menarini, Servier and TIMI Group. Dr. Steg reports research grants from Servier; consultancy fees/honoraria from Amgen, Astellas, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo/Eli Lilly alliance, Eisai, GlaxoSmithKline, Medtronic, Merck Sharpe and Dohme, Pfizer, Roche, Sanofi, Servier, and The Medicines Company; and equity ownership in Aterovax. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Patient flow chart.
Fig 2
Fig 2. Antithrombotic therapy in patients with coronary artery disease and atrial fibrillation with increasing CHA2DS2-VASc score.
Any antiplatelet therapy alone (single or dual) is therefore: a 1,178 (52.8%), b 130 (69.5%), c 542 (56.4%), d 505 (46.9%). Abbreviations: AP, antiplatelet; OAC, oral anticoagulant.
Fig 3
Fig 3. Antithrombotic therapy in patients with coronary artery disease and permanent or non-permanent atrial fibrillation.
Abbreviations: AF, atrial fibrillation; AP, antiplatelet; OAC, oral anticoagulant.
Fig 4
Fig 4. Multivariable logistic regression results for odds of taking any oral anticoagulant therapy (either alone or with an antiplatelet) compared with the antiplatelet alone group.
Abbreviations: AF, atrial fibrillation; CAD, coronary artery disease; CI, confidence interval; CV, cardiovascular; OAC, oral anticoagulant; PCI, percutaneous coronary intervention.
See this image and copyright information in PMC

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