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Title: Predictors of NOAC versus VKA use for stroke prevention in patients with newly diagnosed atrial fibrillation: Results from GARFIELD-AF
Authors: Sylvia Haas
A. John Camm
Jean Pierre Bassand
Pantep Angchaisuksiri
Frank Cools
Ramon Corbalan
Harry Gibbs
Barry Jacobson
Yukihiro Koretsune
Lorenzo G. Mantovani
Frank Misselwitz
Elizaveta Panchenko
Hany Ibrahim Ragy
Janina Stepinska
Alexander GG Turpie
Jitendra PS Sawhney
Jan Steffel
Toon Wei Lim
Karen S. Pieper
Saverio Virdone
Freek WA Verheugt
Ajay K. Kakkar
National University Health System
Instytut Kardiologii im. Prymasa Tysiaclecia Stefana Kardynała Wyszynskiego
National Medical Research Center of Cardiology, Moscow
Osaka National Hospital
McMaster University
Universite de Franche-Comte
Duke Clinical Research Institute
Pontificia Universidad Católica de Chile
St George's University of London
Algemeen Ziekenhuis Klina
Sir Ganga Ram Hospital
Our Lady Hospital - Amsterdam
Technical University of Munich
UniversitatsSpital Zurich
University of Witwatersrand
Faculty of Medicine, Ramathibodi Hospital, Mahidol University
Thrombosis Research Institute
University of Milano - Bicocca
Alfred Hospital
Bayer AG
National Heart Institute
Keywords: Medicine
Issue Date: 1-Jul-2019
Citation: American Heart Journal. Vol.213, (2019), 35-46
Abstract: © 2019 The Authors Introduction: A principal aim of the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) was to document changes in treatment practice for patients with newly diagnosed atrial fibrillation during an era when non–vitamin K antagonist oral anticoagulants (NOACs) were becoming more widely adopted. In these analyses, the key factors which determined the choice between NOACs and vitamin K antagonists (VKAs) are explored. Methods: Logistic least absolute shrinkage and selection operator regression determined predictors of NOAC and VKA use. Data were collected from 24,137 patients who were initiated on AC ± antiplatelet (AP) therapy (NOAC [51.4%] or VKA [48.6%]) between April 2013 and August 2016. Results: The most significant predictors of AC therapy were country, enrolment year, care setting at diagnosis, AF type, concomitant AP, and kidney disease. Patients enrolled in emergency care or in the outpatient setting were more likely to receive a NOAC than those enrolled in hospital (OR 1.16 [95% CI: 1.04-1.30], OR: 1.15 [95% CI: 1.05-1.25], respectively). NOAC prescribing seemed to be favored in lower-risk groups, namely, patients with paroxysmal AF, normotensive patients, and those with moderate alcohol consumption, but also the elderly and patients with acute coronary syndrome. By contrast, VKAs were preferentially used in patients with permanent AF, moderate to severe kidney disease, heart failure, vascular disease, and diabetes and with concomitant AP. Conclusion: GARFIELD-AF data highlight marked heterogeneity in stroke prevention strategies globally. Physicians are adopting an individualized approach to stroke prevention where NOACs are favored in patients with a lower stroke risk but also in the elderly and patients with acute coronary syndrome.
ISSN: 10976744
Appears in Collections:Scopus 2019

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