PMID- 29281086 OWN - NLM STAT- MEDLINE DCOM- 20191114 LR - 20191114 IS - 1522-9645 (Electronic) IS - 0195-668X (Linking) VI - 39 IP - 6 DP - 2018 Feb 7 TI - Characteristics of patients with atrial fibrillation prescribed antiplatelet monotherapy compared with those on anticoagulants: insights from the GARFIELD-AF registry. PG - 464-473 LID - 10.1093/eurheartj/ehx730 [doi] AB - AIMS: Current atrial fibrillation (AF) guidelines discourage antiplatelet (AP) monotherapy as alternative to anticoagulants (ACs). Why AP only is still used is largely unknown. METHODS AND RESULTS: Factors associated with AP monotherapy prescription were analysed in GARFIELD-AF, a registry of patients with newly diagnosed (/=1 investigator-determined stroke risk factor. We analysed 51 270 patients from 35 countries enrolled into five sequential cohorts between 2010 and 2016. Overall, 20.7% of patients received AP monotherapy, 52.1% AC monotherapy, and 14.1% AP + AC. Most AP monotherapy (82.5%) and AC monotherapy (86.8%) patients were CHA2DS2-VASc >/=2. Compared with patients on AC monotherapy, AP monotherapy patients 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). 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). Antiplatelet monotherapy patients were less likely to have paroxysmal (0.67) or permanent AF (0.57), history of embolism (0.56), or alcohol use (0.90). With each cohort, AP monotherapy declined (P<0.0001), especially non-indicated use. AP + AC and no antithrombotic therapy were unchanged. However, even in 2015 and 2016, about 50% of AP-treated patients had no indication except AF (71% were CHA2DS2-VASc >/=2). CONCLUSION: Prescribing AP monotherapy in newly diagnosed AF has declined, but even nowadays a substantial proportion of AP-treated patients with AF have no indication for AP. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362. CI - Published on behalf of the European Society of Cardiology. All rights reserved. (c) The Author 2017. For permissions, please email: journals.permissions@oup.com. FAU - Verheugt, Freek W A AU - Verheugt FWA AD - Department of Cardiology, Onze Lieve Vrouwe Gasthuis (OLVG), Oosterpark 9, 1091 AC Amsterdam, The Netherlands. FAU - Gao, Haiyan AU - Gao H AD - Thrombosis Research Institute, Emmanuel Kaye Building, Manresa Road, London SW3 6LR, UK. FAU - Al Mahmeed, Wael AU - Al Mahmeed W AD - Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Al Falah Street, Al Maryah Island, Abu Dhabi, UAE. FAU - Ambrosio, Giuseppe AU - Ambrosio G AD - Division of Cardiology, University of Perugia School of Medicine Cardiology, Via S. Andrea delle Fratte, 06126 Perugia, Italy. FAU - Angchaisuksiri, Pantep AU - Angchaisuksiri P AD - Department of Medicine, Division of Hematology, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok 10400, Thailand. FAU - Atar, Dan AU - Atar D AD - Department of Cardiology B, Oslo University Hospital Ulleval, and Faculty of Medicine, University of Oslo, Kirkeveien 166, N-0407 Oslo, Norway. FAU - Bassand, Jean-Pierre AU - Bassand JP AD - Thrombosis Research Institute, Emmanuel Kaye Building, Manresa Road, London SW3 6LR, UK. AD - Department of Cardiology EA 3920, University of Besancon, Besancon, France. FAU - Camm, A John AU - Camm AJ AD - Cardiovascular and Cell Sciences Research Institute, St. George's University of London, Cranmer Terrace, London SW17 0RE, UK. FAU - Cools, Frank AU - Cools F AD - AZ Klina, Augustijnslei 100, 2930 Brasschaat, Belgium. FAU - Eikelboom, John AU - Eikelboom J AD - Population Health Research Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada. FAU - Kayani, Gloria AU - Kayani G AD - Thrombosis Research Institute, Emmanuel Kaye Building, Manresa Road, London SW3 6LR, UK. FAU - Lim, Toon Wei AU - Lim TW AD - National University Heart Centre, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore 119228. FAU - Misselwitz, Frank AU - Misselwitz F AD - Pharmaceuticals Division, Bayer Pharma AG, Therapeutic Area General Medicine, Aprather Weg 18a, 42113 Wuppertal, Germany. FAU - Pieper, Karen S AU - Pieper KS AD - Duke Clinical Research Institute, 2400 Pratt Street, Rm 0311 Terrace Level, Durham, NC 27705, USA. FAU - van Eickels, Martin AU - van Eickels M AD - Medical Affairs & Pharmacovigilance, Pharmaceuticals, MA TA Thrombosis & Ophthalmology, Bayer AG, Building S101, S101 4.134, 13342 Berlin, Germany. FAU - Kakkar, Ajay K AU - Kakkar AK AD - Thrombosis Research Institute, Emmanuel Kaye Building, Manresa Road, London SW3 6LR, UK. AD - University College London, Gower Street, Bloomsbury, London WC1E 6BT, UK. CN - GARFIELD-AF Investigators LA - eng SI - ClinicalTrials.gov/NCT01090362 PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - Eur Heart J JT - European heart journal JID - 8006263 RN - 0 (Anticoagulants) RN - 0 (Platelet Aggregation Inhibitors) SB - IM CIN - Eur Heart J. 2018 Feb 7;39(6):474-476. PMID: 29329381 MH - Aged MH - Anticoagulants/*therapeutic use MH - *Atrial Fibrillation/drug therapy/epidemiology MH - Female MH - Humans MH - Male MH - Middle Aged MH - Platelet Aggregation Inhibitors/*therapeutic use MH - Prospective Studies MH - Risk Factors OTO - NOTNLM OT - Anticoagulant therapy OT - Antiplatelet therapy OT - Atrial fibrillation EDAT- 2017/12/28 06:00 MHDA- 2019/11/15 06:00 CRDT- 2017/12/28 06:00 PHST- 2017/06/06 00:00 [received] PHST- 2017/11/23 00:00 [accepted] PHST- 2017/12/28 06:00 [pubmed] PHST- 2019/11/15 06:00 [medline] PHST- 2017/12/28 06:00 [entrez] AID - 4769347 [pii] AID - 10.1093/eurheartj/ehx730 [doi] PST - ppublish SO - Eur Heart J. 2018 Feb 7;39(6):464-473. doi: 10.1093/eurheartj/ehx730.