Antithrombotic therapy use in patients with atrial fibrillation before the era of non-vitamin K antagonist oral anticoagulants: the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF) Phase I cohort
Open Access
- 21 June 2016
- journal article
- research article
- Published by Oxford University Press (OUP) in EP Europace
- Vol. 18 (9), 1308-1318
- https://doi.org/10.1093/europace/euw073
Abstract
The introduction of non-VKA oral anticoagulants (NOACs), which differ from the earlier vitamin K antagonist (VKA) treatments, has changed the approach to stroke prevention in atrial fibrillation (AF). GLORIA-AF is a prospective, global registry programme describing the selection of antithrombotic treatment in newly diagnosed AF patients at risk of stroke. It comprises three phases: Phase I, before the introduction of NOACs; Phase II, during the time of the introduction of dabigatran, the first NOAC; and Phase III, once NOACs have been established in clinical practice. In Phase I, 1063 patients were eligible from the 1100 enrolled (54.3% male; median age 70 years); patients were from China (67.1%), Europe (EU; 27.4%), and the Middle East (ME; 5.6%). The majority of patients using VKAs had high stroke risk (CHA2DS2-VASc ≥ 2; 86.5%); 13.5% had moderate risk (CHA2DS2-VASc = 1). Vitamin K antagonist use was higher for persistent/permanent AF (47.7%) than that for paroxysmal (23.9%). Most patients in China were treated with antiplatelet agents (53.7%) vs. 27.1% in EU and 28.8% in ME. In China, 25.9% of patients had no antithrombotic therapy, vs. 8.6% in EU and 8.5% in ME. Phase I of GLORIA-AF shows that VKAs were mostly used in patients with persistent/permanent (vs. paroxysmal) AF and in those with high stroke risk. Furthermore, there were meaningful geographical differences in the use of VKA therapy in the era before the availability of NOACs, including a much lower use of VKAs in China, where most patients either received antiplatelet agents or no antithrombotic treatment.Keywords
Funding Information
- Boehringer Ingelheim
- National Institutes of Health
This publication has 19 references indexed in Scilit:
- Parenteral anticoagulants in heart disease: Current status and perspectives (Section II)Thrombosis and Haemostasis, 2013
- Guidelines for the management of atrial fibrillationEP Europace, 2010
- Dabigatran versus Warfarin in Patients with Atrial FibrillationThe New England Journal of Medicine, 2009
- Association of obesity and atrial fibrillation among middle-aged and elderly ChineseInternational Journal of Obesity, 2009
- An Epidemiological Study on the Prevalence of Atrial Fibrillation in the Chinese Population of Mainland ChinaJournal of Epidemiology, 2008
- Meta-analysis: Antithrombotic Therapy to Prevent Stroke in Patients Who Have Nonvalvular Atrial FibrillationAnnals of Internal Medicine, 2007
- Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam studyEuropean Heart Journal, 2006
- Lifetime Risk for Development of Atrial FibrillationCirculation, 2004
- Stroke Severity in Atrial FibrillationStroke, 1996
- Atrial fibrillation as an independent risk factor for stroke: the Framingham Study.Stroke, 1991