TY - JOUR
T1 - Characteristics of patients with atrial fibrillation prescribed antiplatelet monotherapy compared with those on anticoagulants
T2 - Insights from the GARFIELD-AF registry
AU - the GARFIELD-AF Investigators
AU - Verheugt, Freek W.A.
AU - Gao, Haiyan
AU - Al Mahmeed, Wael
AU - Ambrosio, Giuseppe
AU - Angchaisuksiri, Pantep
AU - Atar, Dan
AU - Bassand, Jean Pierre
AU - Camm, A. John
AU - Cools, Frank
AU - Eikelboom, John
AU - Kayani, Gloria
AU - Lim, Toon Wei
AU - Misselwitz, Frank
AU - Pieper, Karen S.
AU - Van Eickels, Martin
AU - Kakkar, Ajay K.
AU - Fitzmaurice, David A.
AU - Goldhaber, Samuel Z.
AU - Goto, Shinya
AU - Haas, Sylvia
AU - Hacke, Werner
AU - Mantovani, Lorenzo G.
AU - Turpie, Alexander G.G.
AU - Fox, Keith A.A.
AU - Gersh, Bernard J.
AU - Luciardi, Hector Lucas
AU - Gibbs, Harry
AU - Brodmann, Marianne
AU - Barretto, Antonio Carlos Pereira
AU - Connolly, Stuart J.
AU - Spyropoulos, Alex
AU - Corbalan, Ramon
AU - Hu, Dayi
AU - Jansky, Petr
AU - Nielsen, Jørn Dalsgaard
AU - Ragy, Hany
AU - Raatikainen, Pekka
AU - Le Heuzey, Jean Yves
AU - Darius, Harald
AU - Keltai, Matyas
AU - Kakkar, Sanjay
AU - Sawhney, Jitendra Pal Singh
AU - Agnelli, Giancarlo
AU - Koretsune, Yukihiro
AU - Díaz, Carlos Jerjes Sánchez
AU - ten Cate, Hugo
AU - Stepinska, Janina
AU - Panchenko, Elizaveta
AU - Jacobson, Barry
AU - Diercks, D.
N1 - Funding Information:
Conflict of interest: F.W.A.V. reports grants and personal fees from Bayer Healthcare, personal fees from BMS/Pfizer, personal fees from Daiichi-Sankyo, personal fees from Boehringer-Ingelheim, outside the submitted work. H.G. reports grants from Bayer AG, during the conduct of the study. W.A.M. has nothing to disclose. G.A. reports personal fees from Merck, personal fees from Menarini, personal fees from Angelini, personal fees from Behring, outside the submitted work. P.A. has nothing to disclose. D.A. reports personal fees from Bayer Healthcare, personal fees from BMS/Pfizer, personal fees from Boehringer-Ingelheim, personal fees from MSD, outside the submitted work. J.-P.B. reports personal fees from Aspen, outside the submitted work. A.J.C. reports personal fees from Bayer, personal fees from Boehringer Ingelheim, personal fees from Pfizer/BMS, personal fees from Daiichi Sankyo, outside the submitted work. F.C. reports personal fees from Bayer, personal fees from BMS, personal fees from Boehringer-Ingelheim, outside the submitted work. J.E. reports personal fees from Astra-Zeneca, personal fees from Bayer, personal fees from Boehringer-Ingelheim, personal fees from Bristol-Myer-Squibb, personal fees from Daiichi-Sankyo, personal fees from Eli-Lilly, personal fees from Glaxo-Smith-Kline, personal fees from Pfizer, personal fees from Janssen, personal fees from Sanofi-Aventis, grants from Astra-Zeneca, grants from Bayer, grants from Boehringer-Ingelheim, grants from Bristol-Myer-Squibb, grants from Glaxo-Smith-Kline, grants from Pfizer, grants from Janssen, grants from Sanofi-Aventis, outside the submitted work. G.K. reports grants from Bayer AG, during the conduct of the study. T.W.L. reports personal fees from Pfizer/BMS, personal fees from Bayer, grants and personal fees from Medtronic, personal fees from St Jude Medical, personal fees from Biotronik, grants from Boehringer-Ingelheim, outside the submitted work. F.M. is an employee of Bayer AG. K.S.P. reports personal fees from Thrombosis Research Institute, during the conduct of the study. M.v.E. is an employee of Bayer AG. A.K.K. reports grants from Bayer AG, during the conduct of the study; grants and personal fees from Bayer AG, personal fees from Boehringer-Ingelheim Pharma, personal fees from Daiichi Sankyo Europe, personal fees from Janssen Pharma, personal fees from Sanofi SA, outside the submitted work.
Funding Information:
This work was supported by an unrestricted research grant from Bayer AG (Berlin, Germany) to the Thrombosis Research Institute (London, UK), which sponsors the GARFIELD-AF registry.
Publisher Copyright:
© The Author 2017.
PY - 2018/2/7
Y1 - 2018/2/7
N2 - 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. All rights reserved.
AB - 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. All rights reserved.
KW - Anticoagulant therapy
KW - Antiplatelet therapy
KW - Atrial fibrillation
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U2 - 10.1093/eurheartj/ehx730
DO - 10.1093/eurheartj/ehx730
M3 - Article
C2 - 29281086
AN - SCOPUS:85042516795
VL - 39
SP - 464
EP - 473
JO - European Heart Journal
JF - European Heart Journal
SN - 0195-668X
IS - 6
ER -