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CC BY-NC-ND 4.0 · Thromb Haemost 2017; 117(12): 2376-2388
DOI: 10.1160/TH17-08-0555
Stroke, Systemic or Venous Thromboembolism
Schattauer GmbH Stuttgart

Regional Differences in Antithrombotic Treatment for Atrial Fibrillation: Insights from the GLORIA-AF Phase II Registry

Michał Mazurek
1   Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
2   Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Zabrze, Poland
,
Menno V. Huisman
3   Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
,
Kenneth J. Rothman
4   RTI Health Solutions, Research Triangle Institute, Research Triangle Park, North Carolina, United States
,
Miney Paquette
5   Department of Medicine, Boehringer Ingelheim, Burlington, Canada
,
Christine Teutsch
6   Department of Clinical Development and Medical Affairs, Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
,
Hans-Christoph Diener
7   Department of Neurology, University of Duisburg-Essen, Duisburg, Germany
,
Sergio J. Dubner
8   Clínica y Maternidad Suizo Argentina, Buenos Aires, Argentina
,
Jonathan L. Halperin
9   Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
Chang Sheng Ma
10   Department of Cardiology, Atrial Fibrillation Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
,
Kristina Zint
11   Department of Cardiology, Atrial Fibrillation Center, Boehringer Ingelheim, Ingelheim, Germany
,
Amelie Elsaesser
12   Department of Biostatistics and Data Sciences, Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
,
Shihai Lu
13   Department of Biostatistics and Data Sciences, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut, United States
,
Gregory Y. H. Lip
1   Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
14   Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
,
on behalf of the GLORIA-AF Investigators › Author Affiliations
Further Information

Publication History

13 August 2017

16 August 2017

Publication Date:
06 December 2017 (online)

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Abstract

Introduction Although guideline-adherent antithrombotic therapy (ATT) for stroke prevention in atrial fibrillation (AF) is associated with lower mortality and thromboembolism, ATT uptake shows geographic variation worldwide. We aimed to assess thromboembolic risk and baseline ATT by geographic region and identify factors associated with prescription of ATT in a large, truly global registry of patients with recently diagnosed AF.

Methods and Results Our analysis comprises 15,092 patients newly diagnosed with non-valvular AF at risk for stroke, enrolled in Phase II of Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF). Global oral anticoagulation (OAC) use was 79.9%, being highest in Europe (90.1%), followed by Africa/Middle East (87.4%) and Latin America (85.3%), North America (78.3%) and Asia (55.2%). Among OAC users, vitamin K antagonists (VKAs) have been replaced by non-VKA OACs (NOACs) as the more prevalent OAC option in all regions, with highest use in North America (66.5%) and lowest in Asia (50.2%). In Asia, OAC was 80.4% in community hospitals but only 49.8% in university hospitals and 42.6% in specialist offices, and varied from 21.0% in China to 89.7% in Japan (NOACs at 5.8% in China and 83.3% in Japan). Globally, 76.5% of low-risk patients were prescribed ATT (46.1% OAC), whereas 17.7% high-risk patients were not anticoagulated (Europe 8.8%; North America 18.9%; Asia 42.4%).

Conclusion Substantial inter- and intra-regional differences in ATT for stroke prevention in AF are evident in this global registry. While guideline-adherent ATT can be further improved, NOACs are the main contributor to high OAC use worldwide.

Keywords

atrial fibrillation - anticoagulation - stroke prevention - regional differences - GLORIA-AF

Funding

This work was supported by Boehringer Ingelheim GmbH.


Clinical Trial Registration

http://www.clinicaltrials.gov. Unique identifier: NCT01468701.


The review process for this paper was fully handled by Christian Weber, Editor in Chief.


Supplementary Material

 

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