Characteristics of patients with atrial fibrillation prescribed antiplatelet monotherapy compared with those on anticoagulants: insights from the GARFIELD-AF registry

Freek W A Verheugt¹, Haiyan Gao², Wael Al Mahmeed³, Giuseppe Ambrosio⁴, Pantep Angchaisuksiri⁵, Dan Atar⁶, Jean-Pierre Bassand^{2

7}, A John Camm⁸, Frank Cools⁹, John Eikelboom¹⁰, Gloria Kayani², Toon Wei Lim¹¹, Frank Misselwitz¹², Karen S Pieper¹³, Martin van Eickels¹⁴, Ajay K Kakkar^{2

15}; GARFIELD-AF Investigators

Affiliations

¹ Department of Cardiology, Onze Lieve Vrouwe Gasthuis (OLVG), Oosterpark 9, 1091 AC Amsterdam, The Netherlands.
² Thrombosis Research Institute, Emmanuel Kaye Building, Manresa Road, London SW3 6LR, UK.
³ Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Al Falah Street, Al Maryah Island, Abu Dhabi, UAE.
⁴ Division of Cardiology, University of Perugia School of Medicine Cardiology, Via S. Andrea delle Fratte, 06126 Perugia, Italy.
⁵ Department of Medicine, Division of Hematology, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok 10400, Thailand.
⁶ Department of Cardiology B, Oslo University Hospital Ullevål, and Faculty of Medicine, University of Oslo, Kirkeveien 166, N-0407 Oslo, Norway.
⁷ Department of Cardiology EA 3920, University of Besançon, Besançon, France.
⁸ Cardiovascular and Cell Sciences Research Institute, St. George's University of London, Cranmer Terrace, London SW17 0RE, UK.
⁹ AZ Klina, Augustijnslei 100, 2930 Brasschaat, Belgium.
¹⁰ Population Health Research Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada.
¹¹ National University Heart Centre, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore 119228.
¹² Pharmaceuticals Division, Bayer Pharma AG, Therapeutic Area General Medicine, Aprather Weg 18a, 42113 Wuppertal, Germany.
¹³ Duke Clinical Research Institute, 2400 Pratt Street, Rm 0311 Terrace Level, Durham, NC 27705, USA.
¹⁴ Medical Affairs & Pharmacovigilance, Pharmaceuticals, MA TA Thrombosis & Ophthalmology, Bayer AG, Building S101, S101 4.134, 13342 Berlin, Germany.
¹⁵ University College London, Gower Street, Bloomsbury, London WC1E 6BT, UK.

PMID: 29281086
DOI: 10.1093/eurheartj/ehx730

Characteristics of patients with atrial fibrillation prescribed antiplatelet monotherapy compared with those on anticoagulants: insights from the GARFIELD-AF registry

Freek W A Verheugt et al. Eur Heart J. 2018.

. 2018 Feb 7;39(6):464-473.

doi: 10.1093/eurheartj/ehx730.

Authors

Affiliations

¹ Department of Cardiology, Onze Lieve Vrouwe Gasthuis (OLVG), Oosterpark 9, 1091 AC Amsterdam, The Netherlands.
² Thrombosis Research Institute, Emmanuel Kaye Building, Manresa Road, London SW3 6LR, UK.
³ Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Al Falah Street, Al Maryah Island, Abu Dhabi, UAE.
⁴ Division of Cardiology, University of Perugia School of Medicine Cardiology, Via S. Andrea delle Fratte, 06126 Perugia, Italy.
⁵ Department of Medicine, Division of Hematology, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok 10400, Thailand.
⁶ Department of Cardiology B, Oslo University Hospital Ullevål, and Faculty of Medicine, University of Oslo, Kirkeveien 166, N-0407 Oslo, Norway.
⁷ Department of Cardiology EA 3920, University of Besançon, Besançon, France.
⁸ Cardiovascular and Cell Sciences Research Institute, St. George's University of London, Cranmer Terrace, London SW17 0RE, UK.
⁹ AZ Klina, Augustijnslei 100, 2930 Brasschaat, Belgium.
¹⁰ Population Health Research Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada.
¹¹ National University Heart Centre, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore 119228.
¹² Pharmaceuticals Division, Bayer Pharma AG, Therapeutic Area General Medicine, Aprather Weg 18a, 42113 Wuppertal, Germany.
¹³ Duke Clinical Research Institute, 2400 Pratt Street, Rm 0311 Terrace Level, Durham, NC 27705, USA.
¹⁴ Medical Affairs & Pharmacovigilance, Pharmaceuticals, MA TA Thrombosis & Ophthalmology, Bayer AG, Building S101, S101 4.134, 13342 Berlin, Germany.
¹⁵ University College London, Gower Street, Bloomsbury, London WC1E 6BT, UK.

PMID: 29281086
DOI: 10.1093/eurheartj/ehx730

Abstract

Aims: Current atrial fibrillation (AF) guidelines discourage antiplatelet (AP) monotherapy as alternative to anticoagulants (ACs). Why AP only is still used is largely unknown.

Methods and results: Factors associated with AP monotherapy prescription were analysed in GARFIELD-AF, a registry of patients with newly diagnosed (≤6 weeks) AF and ≥1 investigator-determined stroke risk factor. We analysed 51 270 patients from 35 countries enrolled into five sequential cohorts between 2010 and 2016. Overall, 20.7% of patients received AP monotherapy, 52.1% AC monotherapy, and 14.1% AP + AC. Most AP monotherapy (82.5%) and AC monotherapy (86.8%) patients were CHA2DS2-VASc ≥2. Compared with patients on AC monotherapy, AP monotherapy patients were frequently Chinese (vs. Caucasian, odds ratio 2.73) and more likely to have persistent AF (1.32), history of coronary artery disease (2.41) or other vascular disease (1.67), bleeding (2.11), or dementia (1.81). The odds for AP monotherapy increased with 5 years of age increments for patients ≥75 years (1.24) but decreased with age increments for patients 55-75 years (0.86). Antiplatelet monotherapy patients were less likely to have paroxysmal (0.67) or permanent AF (0.57), history of embolism (0.56), or alcohol use (0.90). With each cohort, AP monotherapy declined (P<0.0001), especially non-indicated use. AP + AC and no antithrombotic therapy were unchanged. However, even in 2015 and 2016, about 50% of AP-treated patients had no indication except AF (71% were CHA2DS2-VASc ≥2).

Conclusion: Prescribing AP monotherapy in newly diagnosed AF has declined, but even nowadays a substantial proportion of AP-treated patients with AF have no indication for AP.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362.

Keywords: Anticoagulant therapy; Antiplatelet therapy; Atrial fibrillation.

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Comment in

The winding path towards rationale anti-thrombotic therapy to prevent stroke in patients with atrial fibrillation.
Healey JS. Healey JS. Eur Heart J. 2018 Feb 7;39(6):474-476. doi: 10.1093/eurheartj/ehx795. Eur Heart J. 2018. PMID: 29329381 No abstract available.

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Characteristics of patients with atrial fibrillation prescribed antiplatelet monotherapy compared with those on anticoagulants: insights from the GARFIELD-AF registry

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Characteristics of patients with atrial fibrillation prescribed antiplatelet monotherapy compared with those on anticoagulants: insights from the GARFIELD-AF registry

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Abstract

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