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Prescribing Antiplatelet Therapy in Nonvalvular Atrial Fibrillation: GARFIELD-AF Registry

Analysis comparing antiplatelet therapy vs. oral anticoagulation in AF patients. Trends in prescription practice observed over time. Not recommended for low stroke risk.

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Prescribing Antiplatelet Therapy in Nonvalvular Atrial Fibrillation: GARFIELD-AF Registry

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  1. The prescribing of antiplatelet therapy alone in patients with nonvalvular atrial fibrillation: Results from the GARFIELD-AF registryPurpose: To provide an analysis of patients on APT only compared with those prescribed oral AC lone therapy, at enrolment Freek Verheugt, Dan Atar, A. John Camm, Pantep Angchaisuksiri, Giuseppe Ambrosio, Jean-Pierre Bassand, Frank Cools, John Eikelboom, Martin van Eickels, Toon Wei Lim, Wael Al Mahmeed, Frank Misselwitz, Anthony Cowell, Ajay K. Kakkar for the GARFIELD-AF investigators SUBMITTED TO ESC 2016

  2. Methods • GARFIELD-AF is an international, observational registry of patients with newly diagnosed nonvalvular AF and ≥1 additional investigator-determined stroke risk factor

  3. Patients on APT only and those on oral AC lone therapy • Between Mar 2010–Jul 2015, 39,670 patients were enrolled prospectively into four sequential cohorts (C) of ~10,000 patients each (C1: 2010–1; C2: 2011–3; C3: 2013–4; C4: 2014–5) from 35 countries • 22.0% (8714) of patients received APT only (mostly aspirin) and 50.6% (20,085) oral AC lone therapy • The majority in both treatment groups (APT: 83.0%; AC: 87.1%) had a moderate-to-high risk of stroke (CHA2DS2-VASc score ≥2); <3.0% of low-risk patients (score 0) received either treatment • Compared with patients on AC lone therapy, patients receiving APT only were more frequently of Asian ethnicity (OR 2.14; 95%CI 2.01–2.28) and were more likely to have a history of dementia, vascular disease or bleeding, but were less likely to be elderly • There were 45% fewer patients in C4 than C1 on APT (30.2% vs 16.6%), with a clear trend towards a reduction in APT prescribing relative to AC

  4. Factors associated with prescription of APT alone

  5. Conclusion • APT alone is widely prescribed in patients with AF, although it is no longer recommended by the ESC for patients at low risk of stroke or as a substitute for oral anticoagulation • Since this change in guidance and the advent of non-VKA oral ACs, the prescribing of APT alone in newly diagnosed patients with nonvalvular AF has diminished

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