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Published on: February 26, 2013
Evolution of antithrombotic therapy for patients with atrial fibrillation: The prospective global GLORIA-AF registry
Lea Beier1, Shihai Lu2, Lionel Riou França3
1Charité-Universitätsmedizin Berlin, Berlin, Germany.
Insights
Oral anticoagulation (OAC) is standard for nonvalvular atrial fibrillation (AF) patients, with novel oral anticoagulants (NOACs) preferred over vitamin K antagonists (VKAs). However, undertreatment persists in some regions, particularly for patients with impaired kidney function.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- The GLORIA-AF Registry Program tracks antithrombotic treatment (ATT) in nonvalvular atrial fibrillation (AF) patients at risk of stroke.
- Phase III of the registry focused on assessing treatment patterns after novel oral anticoagulants (NOACs) became widely available.
Purpose of the Study:
- To evaluate baseline characteristics and ATT prescription trends in newly diagnosed AF patients in GLORIA-AF Phase III.
- To identify predictors of ATT prescription and compare findings with Phase II.
- To assess the real-world utilization of NOACs versus vitamin K antagonists (VKAs).
Main Methods:
- Prospective, global registry enrolling 21,241 patients between 2014 and 2016.
- Analysis of antithrombotic treatment patterns, including oral anticoagulation (OAC), antiplatelets, and no treatment.
- Evaluation of factors influencing the choice between NOACs and VKAs.
Main Results:
- 82% of patients received OAC (59.5% NOACs, 22.7% VKAs); 11% received antiplatelets alone, 7% received no ATT.
- High stroke risk was the primary driver for OAC prescription.
- VKA prescription over NOACs was associated with site type, region, physician specialty, and impaired kidney function.
Conclusions:
- Oral anticoagulation, particularly NOACs, is the standard of care for newly diagnosed AF patients.
- Despite advancements, a notable proportion of patients remain undertreated in certain regions.
- VKAs were favored over NOACs in patients with impaired kidney function, highlighting a need for optimized treatment strategies.
Objective:
To assess baseline characteristics and antithrombotic treatment (ATT) prescription patterns in patients enrolled in the third phase of the GLORIA-AF Registry Program, evaluate predictors of treatment prescription, and compare results with phase II.
Methods:
GLORIA-AF is a large, global, prospective registry program, enrolling patients with newly diagnosed nonvalvular atrial fibrillation (AF) at risk of stroke. Patients receiving dabigatran were followed for two years in phase II, and all patients were followed for 3 years in phase III. Phase II started when dabigatran became available; phase III started when the characteristics of patients receiving dabigatran became roughly comparable with those receiving vitamin K antagonists (VKAs).
Results:
Between 2014 and 2016, 21,241 patients were enrolled in phase III. In total, 82% of patients were prescribed oral anticoagulation ([OAC]; 59.5% novel/nonvitamin K oral anticoagulants [NOACs], 22.7% VKAs). A further 11% of patients were prescribed antiplatelets without OAC and 7% were prescribed no ATT. A high stroke risk was the main driver of OAC prescription. Factors associated with prescription of VKA over NOAC included type of site, region, physician specialty, and impaired kidney function.
Conclusion:
Over the past few years, data from phase III of GLORIA-AF show that OACs have become the standard treatment option, with most newly diagnosed AF patients prescribed a NOAC. However, in some regions a remarkable proportion of patients remain undertreated. In comparison with phase II, more patients received NOACs in phase III while the prescription of VKA decreased. VKAs were preferred over NOACs in patients with impaired kidney function.
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