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Evolving antithrombotic treatment patterns for patients with newly diagnosed atrial fibrillation
  1. A John Camm1,
  2. Gabriele Accetta2,
  3. Giuseppe Ambrosio3,
  4. Dan Atar4,5,
  5. Jean-Pierre Bassand6,
  6. Eivind Berge7,
  7. Frank Cools8,
  8. David A Fitzmaurice9,
  9. Samuel Z Goldhaber10,
  10. Shinya Goto11,
  11. Sylvia Haas12,
  12. Gloria Kayani2,
  13. Yukihiro Koretsune13,
  14. Lorenzo G Mantovani14,
  15. Frank Misselwitz15,
  16. Seil Oh16,
  17. Alexander G G Turpie17,
  18. Freek W A Verheugt18,
  19. Ajay K Kakkar2,19
  20. for the GARFIELD-AF Investigators
  1. 1Division of Cardiovascular Sciences, St George's University of London, London, UK
  2. 2Thrombosis Research Institute, London, UK
  3. 3Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy
  4. 4Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
  5. 5Faculty of Medicine, University of Oslo, Oslo, Norway
  6. 6Department of Cardiology, EA 3920, University of Besançon, Besançon, France
  7. 7Department of Internal Medicine, Oslo University Hospital, Oslo, Norway
  8. 8AZ Klina, Brasschaat, Belgium
  9. 9Department of Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
  10. 10Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
  11. 11Department of Medicine (Cardiology), Tokai University School of Medicine, Isehara, Japan
  12. 12Formerly Haemostasis and Thrombosis Research Group, Institute for Experimental Oncology and Therapy Research, Technical University Munich, Munich, Germany
  13. 13Institute for Clinical Research, National Hospital Organization, Osaka National Hospital, Osaka, Japan
  14. 14Center for Public Health Research (CESP), University of Milano-Bicocca, Milan, Italy
  15. 15Bayer HealthCare Pharmaceuticals, Berlin, Germany
  16. 16Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
  17. 17Department of Medicine, McMaster University, Hamilton, Canada
  18. 18Department of Cardiology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
  19. 19Department of Surgery, University College London, London, UK
  1. Correspondence to Professor A John Camm, St George's University of London, Cranmer Terrace, London SW17 0RE, UK; jcamm{at}


Objective We studied evolving antithrombotic therapy patterns in patients with newly diagnosed non-valvular atrial fibrillation (AF) and ≥1 additional stroke risk factor between 2010 and 2015.

Methods 39 670 patients were prospectively enrolled in four sequential cohorts in the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF): cohort C1 (2010–2011), n=5500; C2 (2011–2013), n=11 662; C3 (2013–2014), n=11 462; C4 (2014–2015), n=11 046. Baseline characteristics and antithrombotic therapy initiated at diagnosis were analysed by cohort.

Results Baseline characteristics were similar across cohorts. Median CHA2DS2-VASc (cardiac failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65–74 and sex category (female)) score was 3 in all four cohorts. From C1 to C4, the proportion of patients on anticoagulant (AC) therapy increased by almost 15% (C1 57.4%; C4 71.1%). Use of vitamin K antagonist (VKA)±antiplatelet (AP) (C1 53.2%; C4 34.0%) and AP monotherapy (C1 30.2%; C4 16.6%) declined, while use of non-VKA oral ACs (NOACs)±AP increased (C1 4.2%; C4 37.0%). Most CHA2DS2-VASc ≥2 patients received AC, and this proportion increased over time, largely driven by NOAC prescribing. NOACs were more frequently prescribed than VKAs in men, the elderly, patients of Asian ethnicity, those with dementia, or those using non-steroidal anti-inflammatory drugs, and current smokers. VKA use was more common in patients with cardiac, vascular, or renal comorbidities.

Conclusions Since NOACs were introduced, there has been an increase in newly diagnosed patients with AF at risk of stroke receiving guideline-recommended therapy, predominantly driven by increased use of NOACs and reduced use of VKA±AP or AP alone.

Trial registration number NCT01090362; Pre-results.

  • Stroke

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  • Collaborators The full list of GARFIELD-AF Investigators are listed in an online supplementary file which is available with this article.

  • Contributors AJC, J-PB, DAF, SZG, SG, SH, GK, LGM, FM, AGGT, FWAV, and AKK contributed to the study design. GAm, DA, EB, FC, SZG, YK, and SO contributed to data acquisition. GAc analysed the data. All authors contributed to data interpretation. AJC drafted the report. All authors critically reviewed the report and approved the final manuscript.

  • Funding The GARFIELD-AF registry is sponsored by the TRI, London, UK, and is supported by an unrestricted research grant from Bayer Pharma AG, Berlin, Germany (AKK). The funding source had no involvement in the data collection, data analysis, or data interpretation.

  • Competing interests AJC: advisor to Bayer, Boehringer Ingelheim, Pfizer/BMS, and Daiichi Sankyo. GAm: advisor to Merck, Menarini, and Angelini. DA: personal fees from Bayer Healthcare, BMS/Pfizer, Boehringer-Ingelheim, and MSD. J-PB: personal fees from Aspen. FC: personal fees from Bayer, BMS, and Boehringer-Ingelheim. DAF: personal fees from BMS/Pfizer, Boehringer-Ingelheim, Daiichi Sankyo, and Bayer. SZG: grants from BiO2 Medical, Boehringer-Ingelheim, Bristol Meyers Squibb, BTG EKOS, Daiichi Sankyo, National Heart Lung and Blood Institute of the National Institutes of Health, Janssen, and Thrombosis Research Group; personal fees from Bayer, Boehringer-Ingelheim, Bristol Meyers Squibb, Daiichi Sankyo, Janssen, and Portola. SG: personal fees from the TRI, Bayer, and AstraZeneca; grants from Sanofi and Pfizer. SH: personal fees from Aspen, Bayer Healthcare, BMS/Pfizer, Daiichi-Sankyo, and Sanofi. YK: grants and personal fees from Daiichi Sankyo and Boehringer-Ingelheim; personal fees from Bayer, Bristol-Meyers Squibb, and Pfizer. LGM: grants and personal fees from Bayer Healthcare and Pfizer; grants from Boehringer Ingelheim; personal fees from Daiichi Sankyo. FM: employee of Bayer Pharma AG. SO: consultant/advisory board payments from Bayer Pharma AG, Bristol-Myers Squibb Korea, Boehringer-Ingelheim Korea, Pfizer Korea, Sanofi-Aventis, and St Jude Medical. AGGT: personal fees from Bayer Healthcare, Janssen Pharmaceutical Research & Development LLC, Astellas, Portola, and Takeda. FWAV: personal fees from Bayer Healthcare, Daiichi-Sankyo, BMS/Pfizer, and Boehringer-Ingelheim. AKK: grants and personal fees from Bayer Healthcare; personal fees from Boehringer-Ingelheim Pharma, Daiichi Sankyo Europe, Sanofi SA, Janssen.

  • Patient consent Obtained.

  • Ethics approval Independent ethics committees and hospital-based institutional review boards.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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