TY - JOUR
T1 - Antithrombotic treatment gap among patients with atrial fibrillation and type 2 diabetes
AU - Guimarães, Patrícia O.
AU - Peterson, Eric D.
AU - Stevens, Susanna R.
AU - Lokhnygina, Yuliya
AU - Green, Jennifer B.
AU - McGuire, Darren K.
AU - Holman, Rury R.
AU - Lopes, Renato D.
N1 - Funding Information:
Dr. Peterson has received grant support from Janssen, Merck, Sanofi, AstraZeneca, Genentech, and Amgen; and has consulting associations with Bayer, Merck, Sanofi, and Janssen. Dr. Lokhnygina has received grants from Merck, Janssen Research & Development, AstraZeneca, GlaxoSmithKline, and Bayer HealthCare AG. Dr. Green has received grants from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline and Sanofi; personal fees from AstraZeneca, Merck, Boehringer-Ingelheim, and NovoNordisk. Dr. McGuire has provided clinical trial leadership for AstraZeneca, Sanofi Aventis, Janssen, Boehringer Ingelheim, Merck & Co, Novo Nordisk, Lexicon, Eisai, GlaxoSmithKline, Esperion, and consultancy for AstraZeneca, Sanofi Aventis, Lilly US, Boehringer Ingelheim, Merck & Co, Pfizer, Novo Nordisk, Applied Therapeutics, and Metavant. Dr. Holman has received grants from AstraZeneca, Bayer AG, and Merck Sharp & Dohme, as well as personal fees from Amgen, Bayer AG, Boehringer Ingelheim, Novo Nordisk, and Servier. Dr. Lopes has received research grants from Bristol Myers Squibb, GlaxoSmithKline, Medtronic, and Pfizer; consulting fees from Bayer, Boehringer-Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, GlaxoSmithKline, Medtronic, Merck, Pfizer, and Portola Pharmaceutical. The other authors have no disclosures to report.
Funding Information:
The TECOS trial was funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.
Publisher Copyright:
© 2019 Elsevier B.V.
PY - 2019/8/15
Y1 - 2019/8/15
N2 - Background: We investigated the use of different antithrombotic therapies at baseline among patients with a history of atrial fibrillation (AF), type 2 diabetes, and established atherosclerotic cardiovascular disease (ASCVD) enrolled in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS). Methods: TECOS participants with a history of AF were stratified by CHA2DS2-VASc score and their antithrombotic use evaluated. Cox proportional hazards models were employed to explore possible associations between history of AF and prespecified clinical outcomes after adjusting for key baseline characteristics. Results: Of the 14,671 TECOS participants, 1167 (8%) had a history of AF, of whom 51.6% were using vitamin K antagonists (VKA); 31.2% used VKA alone, 16.9% used aspirin plus VKA, 1.8% used clopidogrel plus VKA, and 1.7% used aspirin and clopidogrel plus VKA. Aspirin was used by 56.8%: 30.9% used aspirin alone and 7.3% aspirin plus clopidogrel. Clopidogrel alone was used by 2.9%, and 7.3% were not using any antithrombotic medication. Participants with a history of AF had a higher risk of cardiovascular events, including hospitalization for heart failure and all-cause mortality, than those without AF. White, older men with prior myocardial infarction, heart failure, peripheral artery disease, or prior stroke were more likely to develop new-onset AF than others without these characteristics. Conclusions: Almost half of high-risk AF patients with diabetes and established ASCVD in TECOS were not treated with anticoagulation therapy despite clear guideline recommendations for such therapy, highlighting the challenge and potential for clinical improvements in managing these patients in clinical practice. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00790205.
AB - Background: We investigated the use of different antithrombotic therapies at baseline among patients with a history of atrial fibrillation (AF), type 2 diabetes, and established atherosclerotic cardiovascular disease (ASCVD) enrolled in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS). Methods: TECOS participants with a history of AF were stratified by CHA2DS2-VASc score and their antithrombotic use evaluated. Cox proportional hazards models were employed to explore possible associations between history of AF and prespecified clinical outcomes after adjusting for key baseline characteristics. Results: Of the 14,671 TECOS participants, 1167 (8%) had a history of AF, of whom 51.6% were using vitamin K antagonists (VKA); 31.2% used VKA alone, 16.9% used aspirin plus VKA, 1.8% used clopidogrel plus VKA, and 1.7% used aspirin and clopidogrel plus VKA. Aspirin was used by 56.8%: 30.9% used aspirin alone and 7.3% aspirin plus clopidogrel. Clopidogrel alone was used by 2.9%, and 7.3% were not using any antithrombotic medication. Participants with a history of AF had a higher risk of cardiovascular events, including hospitalization for heart failure and all-cause mortality, than those without AF. White, older men with prior myocardial infarction, heart failure, peripheral artery disease, or prior stroke were more likely to develop new-onset AF than others without these characteristics. Conclusions: Almost half of high-risk AF patients with diabetes and established ASCVD in TECOS were not treated with anticoagulation therapy despite clear guideline recommendations for such therapy, highlighting the challenge and potential for clinical improvements in managing these patients in clinical practice. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00790205.
KW - Antithrombotic therapy
KW - Atrial fibrillation
KW - Diabetes
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U2 - 10.1016/j.ijcard.2019.04.085
DO - 10.1016/j.ijcard.2019.04.085
M3 - Article
C2 - 31079973
AN - SCOPUS:85065131365
SN - 0167-5273
VL - 289
SP - 58
EP - 62
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -