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Data From Global Atrial Fibrillation Registry Show Antithrombotic Agents Not Optimally Used to Prevent Stroke
Date:9/2/2014

t University College London and Director of the TRI. "Previous research has demonstrated that patient outcomes can be improved when anticoagulant therapy is used appropriately. However, observations of everyday clinical practice in GARFIELD-AF suggest that important work remains to be done to ensure the implementation of evidence-based best practice, including the selection of suitable patients for anticoagulation and their optimal management."

Preliminary treatment data for 31,666 GARFIELD-AF patients enrolled in 34 countries during the first three of five planned cohorts were presented in an ESC Congress 2014 satellite symposium.[2] Since the initiation of GARFIELD-AF in 2009, regulatory approval for NOACs including factor Xa inhibitors (rivaroxaban, apixaban) and a direct thrombin inhibitor (dabigatran) has altered prescribing patterns by providing an alternative to vitamin K antagonists (VKAs), the established standard of care. The proportion of AF patients receiving a NOAC has increased from 3.1% during cohort 1 (December 2009-October 2011) to 26.4% during cohort 3 (June 2013-June 2014). However, the proportion of patients receiving any anticoagulant only increased from 60.6% to 67.5% in the same period, as fewer patients received a VKA (57.5% to 41.1%).

The 12,448 prospective patients with at least one year of follow up data after AF diagnosis at the time of analysis were included in the three posters presented at ESC Congress 2014.

Only 25% of patients treated with VKAs achieve adequate anticoagulation control[3] 

  • The ESC guidelines suggest that patients can be considered well managed on VKA therapy if they spend at least 70% of their time in the therapeutic range, i.e. with an international normalized ratio (INR) of 2.0-3.0.[4]
  • The requirement for patients on VKA to undergo routine monitoring and dose adjustment, and the diffic
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