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

ulty of maintaining the optimal anticoagulant effect, are an important consideration when choosing between anticoagulant therapies. NOACs are given at fixed doses and exert a predictable anticoagulant effect without the need for monitoring.
  • Of the 5107 GARFIELD-AF patients treated with VKAs and with INR recordings available, only 25% (n=1301) met the 70% standard for VKA control (with INR control measured as frequency in range (FIR)).
  • Patients whose VKA control was sub-optimal were significantly more likely to suffer a stroke, a major bleeding event, and death.
  • 2 in 5 low-risk patients receive anticoagulation against guideline recommendations[5] 

    • AF patients with a CHA2DS2-VASc risk score[6] of 0 are considered by the ESC guidelines to be at low risk of stroke and are not candidates for anticoagulant therapy with either a VKA or a NOAC.[4]
    • Of the 440 GARFIELD-AF patients with a CHA2DS2-VASc score of 0, 40% received an anticoagulant (32.4% received a VKA and 7.6% received a NOAC).
    • The data also confirmed that these low-risk patients tended to have fewer adverse clinical outcomes, including a substantially lower risk of all-cause death, compared to patients with CHA2DS2-VASc ≥1, supporting the guideline recommendation against treating low-risk patients with anticoagulant therapy.

    Older patients are more likely to receive anticoagulant therapy[7] 

    • Amongst GARFIELD-AF patients, increasing age was associated with more frequent oral anticoagulant use, a greater incidence of co-morbidities and higher risks of stroke/systemic embolism, death and major bleeding events.
    • In patients aged 65 or over, cardiovascular death was not the
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