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Original research
Impact of oral anticoagulation in patients with atrial fibrillation at very low thromboembolic risk
  1. Frederik Hendrik Verbrugge1,
  2. Anne-Céline Martin2,3,
  3. Deborah Siegal4,
  4. Karen Pieper5,
  5. Laura Illingworth5,
  6. A John Camm6,
  7. Keith A A Fox7
  1. 1 Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
  2. 2 Medico-surgical Valve Unit, Georges Pompidou European Hospital, AP-HP, Paris, France
  3. 3 Paris University, Innovative Therapies in Haemostasis, INSERM, Paris, France
  4. 4 Department of Medicine, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
  5. 5 Thrombosis Research Institute, London, UK
  6. 6 Institute of Clinical and Molecular Sciences, Department of Cardiology, St. George’s University of London, London, UK
  7. 7 Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Frederik Hendrik Verbrugge, Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven 3000, Belgium; frederik.verbrugge{at}


Objective To investigate reasons for and impact of oral anticoagulation (OAC) in patients with atrial fibrillation (AF) at very low thromboembolic risk.

Methods Individuals with CHA2DS2-VASc score 0 (men) or 1 (women) from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) were studied. Baseline characteristics according to OAC use were evaluated by logistic regression analysis. Non-haemorrhagic stroke or systemic embolism, major bleeding, cardiovascular and all-cause mortality were compared.

Results From 2224 low CHA2DS2-VASc patients in GARFIELD-AF, 44% received OAC. In an adjusted model, increasing age up to 65 years (OR (95% CI)=1.31 (1.19 to 1.44)) and persistent AF (OR (95% CI)=3.25 (2.44 to 4.34)) or permanent AF (OR (95% CI)=2.29 (1.59 to 3.30)) versus paroxysmal/unclassified AF were associated with OAC use. Concomitant antiplatelet therapy (OR (95% CI)=0.21 (0.17 to 0.27)) was inversely associated. Crude incidence rates per 100 person-years over 2 years in patients on OAC versus not on OAC were 0.32 (95% CI 0.14 to 0.71) vs 0.30 (95% CI 0.14 to 0.63) for non-haemorrhagic stroke or systemic embolism, 0.21 (95% CI 0.08 to 0.57) vs 0.17 (95% CI 0.06 to 0.46) for major bleeding, 0.26 (95% CI 0.11 to 0.64) vs 0.26 (95% CI 0.12 to 0.57) for cardiovascular mortality and 0.74 (95% CI 0.44 to 1.25) vs 0.99 (95% CI 0.66 to 1.49) for all-cause mortality.

Conclusions In contrast to guideline recommendations, almost half of real-world patients with AF at a very low thromboembolic risk according to the CHA2DS2-VASc score receive OAC. Persistent or permanent AF and increasing age up to 65 years are associated with OAC use, while concomitant antiplatelet therapy shows an inverse association. Regardless whether patients received OAC therapy, few thromboembolic and bleeding events occur, highlighting the low risk of this population.

  • atrial fibrillation
  • neurologic events
  • stroke

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  • Funding The GARFIELD-AF is funded by an unrestricted research grant from Bayer AG (Berlin, Germany). This study was supported through the Thrombosis Academy for Learning Education and Networking Training (TALENT) programme organised and sponsored by Bayer Healthcare. DS was supported by Research Early Career Award from the Hamilton Health Sciences Foundation. FHV has received travel grants from Bayer Healthcare and consultancy fees from BoehringerIngelheim. DS has received personal fees from Bayer Healthcare, Servier and BMS-Pfizer. AJC and KAAF have received grants and personal fees from Bayer Healthcare.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.