Verheugt FWA, et al. - In this study, researchers used the GARFIELD-AF registry, to determine the characteristics of patients with atrial fibrillation (AF) prescribed antiplatelet (AP) monotherapy vs those on anticoagulants (ACs) and, to analyze the factors associated with AP monotherapy prescription, in order to ultimately find out the reason behind the ongoing use of AP despite guidelines discouraging its use as alternative to ACs in AF. Findings revealed that although prescribing AP monotherapy in newly diagnosed AF has declined, still, there was no indication for AP in a substantial proportion of AP-treated patients with AF.

Methods

• The GARFIELD-AF, a registry of patients with newly diagnosed (≤ 6 weeks) AF and ≥1 investigator-determined stroke risk factor, was used in this study and a total of 51 270 patients from 35 countries enrolled into 5 sequential cohorts between 2010 and 2016 were analyzed.
• Factors associated with AP monotherapy prescription were also analysed

Results

• Data showed that 20.7% of patients received AP monotherapy, 52.1% AC monotherapy, and 14.1% AP + AC.
• Findings also revealed that most AP monotherapy (82.5%) and AC monotherapy (86.8%) patients were CHA₂DS₂-VASc ≥2.
• Researchers noted that AP monotherapy patients vs patients on AC monotherapy were frequently Chinese (vs Caucasian, odds ratio 2.73) and more likely to have persistent AF (1.32), history of coronary artery disease (2.41) or other vascular disease (1.67), bleeding (2.11), or dementia (1.81).
• They also noted that the odds for AP monotherapy increased with 5 years of age increments for patients ≥75 years (1.24) but decreased with age increments for patients 55–75 years (0.86).
• Less likelihood to have paroxysmal (0.67) or permanent AF (0.57), history of embolism (0.56), or alcohol use (0.90) was noted in antiplatelet monotherapy patients.
• With each cohort, decline in AP monotherapy (P<0.0001) was noted, especially non-indicated use.
• In addition, data revealed that AP + AC and no antithrombotic therapy were unchanged.
• However, no indication, except AF (71% were CHA₂DS₂-VASc ≥2), was found in about 50% of AP-treated patients, even in 2015 and 2016.