Sylvia Haas1, A John Camm2, Jean-Pierre Bassand3, Pantep Angchaisuksiri4, Frank Cools5, Ramon Corbalan6, Harry Gibbs7, Barry Jacobson8, Yukihiro Koretsune9, Lorenzo G Mantovani10, Frank Misselwitz11, Elizaveta Panchenko12, Hany Ibrahim Ragy13, Janina Stepinska14, Alexander Gg Turpie15, Jitendra Ps Sawhney16, Jan Steffel17, Toon Wei Lim18, Karen S Pieper19, Saverio Virdone20, Freek Wa Verheugt21, Ajay K Kakkar22. 1. Formerly Technical University of Munich, Munich, Germany. Electronic address: sylvia@sylviahaas.com. 2. Molecular and Clinical Sciences Research Institute, Cardiology Clinical Academic Group, St George's University of London, London, United Kingdom. 3. University of Besançon, Besançon, France; Thrombosis Research Institute, London, United Kingdom. 4. Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. 5. AZ Klina, Brasschaat, Belgium. 6. Catholic University, Santiago, Chile. 7. The Alfred Hospital, Melbourne, Australia. 8. NHLS and University of the Witwatersrand, Charlotte Maxeke Hospital, Johannesburg, South Africa. 9. National Hospital Organization, Osaka National Hospital, Osaka, Japan. 10. University of Milano-Bicocca, Milan, Italy. 11. Bayer AG, Pharmaceuticals, Berlin, Germany. 12. Russian Cardiology Research and Production Center, Department of Atherothrombosis, 3-d Cherepkovskaya str., 15 A, Moscow, Russian Federation. 13. National Heart Institute, Cairo, Egypt. 14. Institute of Cardiology, Warsaw, Poland. 15. McMaster University, Hamilton, Canada. 16. Sir Ganga Ram Hospital, New Delhi, India. 17. University Hospital Zurich, Zurich, Switzerland. 18. National University Heart Centre, Singapore (NUHCS), 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, Republic of Singapore. 19. Thrombosis Research Institute, London, United Kingdom; Duke Clinical Research Institute, Durham, NC, USA. 20. Thrombosis Research Institute, London, United Kingdom. 21. Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands. 22. Thrombosis Research Institute, London, United Kingdom; University College London, London, United Kingdom.
Abstract
INTRODUCTION: A principal aim of the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) was to document changes in treatment practice for patients with newly diagnosed atrial fibrillation during an era when non-vitamin K antagonist oral anticoagulants (NOACs) were becoming more widely adopted. In these analyses, the key factors which determined the choice between NOACs and vitamin K antagonists (VKAs) are explored. METHODS: Logistic least absolute shrinkage and selection operator regression determined predictors of NOAC and VKA use. Data were collected from 24,137 patients who were initiated on AC ± antiplatelet (AP) therapy (NOAC [51.4%] or VKA [48.6%]) between April 2013 and August 2016. RESULTS: The most significant predictors of AC therapy were country, enrolment year, care setting at diagnosis, AF type, concomitant AP, and kidney disease. Patients enrolled in emergency care or in the outpatient setting were more likely to receive a NOAC than those enrolled in hospital (OR 1.16 [95% CI: 1.04-1.30], OR: 1.15 [95% CI: 1.05-1.25], respectively). NOAC prescribing seemed to be favored in lower-risk groups, namely, patients with paroxysmal AF, normotensive patients, and those with moderate alcohol consumption, but also the elderly and patients with acute coronary syndrome. By contrast, VKAs were preferentially used in patients with permanent AF, moderate to severe kidney disease, heart failure, vascular disease, and diabetes and with concomitant AP. CONCLUSION: GARFIELD-AF data highlight marked heterogeneity in stroke prevention strategies globally. Physicians are adopting an individualized approach to stroke prevention where NOACs are favored in patients with a lower stroke risk but also in the elderly and patients with acute coronary syndrome.
INTRODUCTION: A principal aim of the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) was to document changes in treatment practice for patients with newly diagnosed atrial fibrillation during an era when non-vitamin K antagonist oral anticoagulants (NOACs) were becoming more widely adopted. In these analyses, the key factors which determined the choice between NOACs and vitamin K antagonists (VKAs) are explored. METHODS: Logistic least absolute shrinkage and selection operator regression determined predictors of NOAC and VKA use. Data were collected from 24,137 patients who were initiated on AC ± antiplatelet (AP) therapy (NOAC [51.4%] or VKA [48.6%]) between April 2013 and August 2016. RESULTS: The most significant predictors of AC therapy were country, enrolment year, care setting at diagnosis, AF type, concomitant AP, and kidney disease. Patients enrolled in emergency care or in the outpatient setting were more likely to receive a NOAC than those enrolled in hospital (OR 1.16 [95% CI: 1.04-1.30], OR: 1.15 [95% CI: 1.05-1.25], respectively). NOAC prescribing seemed to be favored in lower-risk groups, namely, patients with paroxysmal AF, normotensive patients, and those with moderate alcohol consumption, but also the elderly and patients with acute coronary syndrome. By contrast, VKAs were preferentially used in patients with permanent AF, moderate to severe kidney disease, heart failure, vascular disease, and diabetes and with concomitant AP. CONCLUSION:GARFIELD-AF data highlight marked heterogeneity in stroke prevention strategies globally. Physicians are adopting an individualized approach to stroke prevention where NOACs are favored in patients with a lower stroke risk but also in the elderly and patients with acute coronary syndrome.
Authors: Alma R Oskarsdottir; Brynja R Gudmundsdottir; Hulda M Jensdottir; Bjorn Flygenring; Ragnar Palsson; Pall T Onundarson Journal: Blood Date: 2021-05-20 Impact factor: 22.113
Authors: Farhad Pazan; Ronan Collins; Victor M Gil; Olivier Hanon; Roland Hardt; Martin Hoffmeister; Pedro Monteiro; Terence J Quinn; Dieter Ropers; Giuseppe Sergi; Freek W A Verheugt; Martin Wehling Journal: Drugs Aging Date: 2020-07 Impact factor: 3.923
Authors: Derek S Chew; Flora Au; Yuan Xu; Braden J Manns; Marcello Tonelli; Stephen B Wilton; Brenda Hemmelgarn; Shiying Kong; Derek V Exner; Amity E Quinn Journal: CMAJ Open Date: 2022-08-02