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

Michał Mazurek1,2, Menno V Huisman3, Kenneth J Rothman4

  • 1Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom.

Thrombosis and Haemostasis
|December 7, 2017
PubMed

Insights

Antithrombotic therapy (ATT) for stroke prevention in atrial fibrillation (AF) varies globally. Non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly used, but significant regional disparities in ATT uptake persist, especially in Asia.

Area of Science:

  • Cardiology
  • Pharmacology
  • Public Health

Background:

  • Guideline-adherent antithrombotic therapy (ATT) significantly reduces mortality and thromboembolism in atrial fibrillation (AF) patients.
  • Global uptake of ATT for stroke prevention in AF exhibits considerable geographic variation.
  • Understanding these variations is crucial for optimizing patient care and reducing stroke risk worldwide.

Purpose of the Study:

  • To assess thromboembolic risk and baseline antithrombotic therapy (ATT) in patients with newly diagnosed atrial fibrillation (AF) across different geographic regions.
  • To identify factors associated with the prescription of ATT in a global registry of AF patients.
  • To analyze the uptake and regional differences of oral anticoagulation (OAC) and non-VKA OACs (NOACs).

Main Methods:

  • Analysis of 15,092 patients newly diagnosed with non-valvular AF and at risk for stroke, enrolled in Phase II of the GLORIA-AF registry.
  • Assessment of global oral anticoagulation (OAC) use, including vitamin K antagonists (VKAs) and non-VKA OACs (NOACs), by geographic region.
  • Evaluation of ATT prescription rates based on patient thromboembolic risk (low-risk vs. high-risk) and healthcare setting.

Main Results:

  • Global oral anticoagulation (OAC) use was 79.9%, with highest rates in Europe (90.1%) and lowest in Asia (55.2%).
  • Non-VKA OACs (NOACs) have replaced VKAs as the predominant OAC in all regions, though usage varied significantly (e.g., 66.5% in North America vs. 50.2% in Asia).
  • Substantial intra-regional variations were observed, particularly in Asia, with significant differences in OAC use between community hospitals, university hospitals, and specialist offices, and between countries like China and Japan.
  • 17.7% of high-risk patients globally were not anticoagulated, with rates as high as 42.4% in Asia.

Conclusions:

  • Significant inter- and intra-regional disparities in antithrombotic therapy (ATT) for stroke prevention in atrial fibrillation (AF) exist globally.
  • While guideline-adherent ATT can be improved, non-VKA OACs (NOACs) are a major driver of increased OAC use worldwide.
  • Addressing these geographic and healthcare setting variations is essential to ensure equitable and effective stroke prevention in AF patients.

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