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American Journal of Medicine, The

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Antithrombotic Treatment Patterns in Patients with Newly Diagnosed Nonvalvular Atrial Fibrillation: The GLORIA-AF Registry, Phase II - 21/11/15

Doi : 10.1016/j.amjmed.2015.07.013 
Menno V. Huisman, MD a, Kenneth J. Rothman, DrPH b, Miney Paquette, MSc c, Christine Teutsch, MD d, Hans Christoph Diener, MD e, Sergio J. Dubner, MD f, Jonathan L. Halperin, MD g, Changsheng Ma, MD h, Kristina Zint, MD d, Amelie Elsaesser, MD d, Dorothee B. Bartels, MD d, Gregory Y.H. Lip, MD i, ⁎
on behalf of the

GLORIA-AF Investigators

a Leiden University Medical Center, Leiden, The Netherlands 
b RTI Health Solutions, Research Triangle Institute, Research Triangle Park, NC 
c Boehringer Ingelheim, Burlington, ON, Canada 
d Boehringer Ingelheim, Frankfurt am Main, Germany 
e University of Duisburg-Essen, Germany 
f Clínica y Maternidad Suizo Argentina, Buenos Aires, Argentina 
g Icahn School of Medicine at Mount Sinai, New York, NY 
h Beijing AnZhen Hospital, Capital Medical University, Beijing, China 
i University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK 

∗Requests for reprints should be addressed to Gregory Y. H. Lip, MD, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK.

Abstract

Background

The Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF) was designed to provide prospectively collected information on patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke, with the aim of addressing treatment patterns and questions of effectiveness and safety.

Methods and Results

In this predefined analysis from GLORIA-AF, the baseline characteristics and initial antithrombotic management of the first 10,000 patients in Phase II of this large Registry Program are presented. Overall, 32.3% of patients received vitamin K antagonists (VKAs) and 47.7% received non-VKA oral anticoagulants (NOACs), while 12.3% received antiplatelet treatment and 7.6% did not receive any antithrombotic treatment. Among patients with CHA2DS2-VASc score ≥2, 6.7% received no antithrombotic treatment and 10.0% received aspirin. In Europe, treatment with dabigatran was as common as treatment with VKAs (38.8% and 37.8%, respectively). More than half of the patients were treated with NOACs (52.4%), while antiplatelet treatment was given to 5.7%, and 4.1% did not receive any antithrombotic treatment. In North America, treatment with dabigatran (25.0%) was as common as with VKAs (26.1%), but overall NOAC use was more common (52.1%) than with VKAs (26.1%); however, 14.1% received antiplatelet treatment, while 7.6% received no antithrombotic treatment. In Asia, treatment with VKAs (31.9%) was more prevalent than NOACs (25.5%), but antiplatelet treatment was given to 25.8%, and 16.9% did not receive any antithrombotic treatment. In Asia, only 60.7% of patients with high stroke risk received oral anticoagulants (OACs). Paroxysmal atrial fibrillation and minimally symptomatic (or asymptomatic) patients were often undertreated with OACs.

Conclusion

In this analysis, OAC use was high in Europe and North America, with overall NOAC use higher than VKA use. A considerable percentage of high-risk patients in North America still received antiplatelet treatment or were untreated, while Asian patients had a high proportion of aspirin use and nontreatment.

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Keywords : Anticoagulation, Atrial fibrillation, Registry, Stroke


Plan


 Funding: This registry was funded by Boehringer Ingelheim.
 Conflict of Interest: MVH has provided consulting for Boehringer Ingelheim. CSM has no conflicts of interest to declare. HCD has received honoraria for participation in clinical trials or contribution to advisory boards or oral presentations from Abbott, Allergan, AstraZeneca, Bayer Vital, Bristol-Myers Squibb, Boehringer Ingelheim, CoAxia, Corimmun, Covidien, Daiichi-Sankyo, D-Pharm, Fresenius, GlaxoSmithKline (GSK), Janssen-Cilag, Johnson & Johnson, Knoll, Lilly, Merck Sharp & Dohme, Medtronic, MindFrame, Neurobiological Technologies, Novartis, Novo Nordisk, Paion, Parke-Davis, Pfizer, Sanofi Aventis, Schering-Plough, Servier, Solvay, St. Jude, Syngis, Talecris, Thrombogenics, WebMD Global, Wyeth, and Yamanouchi; received financial support for research projects from AstraZeneca, GSK, Boehringer Ingelheim, Lundbeck, Novartis, Janssen-Cilag, Sanofi Aventis, Syngis, and Talecris; the Department of Neurology at the University Duisburg-Essen received research grants from the German Research Council, German Ministry of Education and Research, European Union, the National Institutes of Health, the Bertelsmann Foundation, and the Heinz-Nixdorf Foundation. HCD has no ownership interest and does not own stocks of any pharmaceutical company. SJD is currently participating in research sponsored by Boehringer Ingelheim. JLH is currently conducting research sponsored by Boehringer Ingelheim as a member of the Executive Steering Committee for the GLORIA-AF Registry. KJR has no conflicts of interest to declare. CT, AE, MP, and DBB are employees of Boehringer Ingelheim. GYHL has served as a consultant for Bayer, Merck, Sanofi, BMS/Pfizer, Daiichi-Sankyo, Biotronik, Medtronic, Portola, and Boehringer Ingelheim; and has been on the speakers bureau for Bayer, BMS/Pfizer, Boehringer Ingelheim, Daiichi-Sankyo, and Medtronic.
 Authorship: All authors had access to the data and a role in writing the manuscript.


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Vol 128 - N° 12

P. 1306 - décembre 2015 Retour au numéro
Article précédent Article précédent
  • National Trends in Ambulatory Oral Anticoagulant Use
  • Geoffrey D. Barnes, Eleanor Lucas, G. Caleb Alexander, Zachary D. Goldberger
| Article suivant Article suivant
  • The Incidence and Outcomes of Ischemic Hepatitis: A Systematic Review with Meta-analysis
  • Elliot B. Tapper, Neil Sengupta, Alan Bonder

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