Stroke Prevention in Atrial Fibrillation. Findings from the GLORIA-AF Registry

Abstract

espanolIntroduccion: GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) es un registro internacional, prospectivo, en 3 fases, para determinar la seguridad y eficacia de dabigatran en pacientes con fibrilacion auricular no valvular recientemente diagnosticada en riesgo de stroke. La Fase 2 empezo cuando el dabigatran, el primer anticoagulante oral no vitamina K antagonista (NOAC) estuvo disponible. Objetivos: Describir los datos clinicos basales de la fase 2 en la poblacion general y el seguimiento a 2 anos de aquellos que recibieron dabigatran. Material y Metodos: Se incluyeron un total de 15644 pacientes de los cuales 15308 fueron elegibles y 4873 recibieron dabigatran. Se analizaron las caracteristicas de la Fibrilacion auricular, hallazgos en el seguimiento y las enfermedades concomitantes. Los datos fueron analizados usando estadisticas descriptivas. Resultados: Del total de pacientes elegibles, 45.5% eran mujeres, con una edad promedio de 71.0 (rango intercuartilo: 64, 78) anos. Los pacientes eran de Europa (47.9%), America del Norte (22.2%), Asia (20.1%), America Latina (6.0%), y Medio Oriente/Africa (3.9%). La mayoria se encontraba en alto riesgo de stroke (CHA2DS2-VASc score > 2; 86.1%); 13.9% tuvieron riesgo moderado (CHA2DS2-VASc > 1). En general, 80.3% recibieron anticoagulantes orales, de ellos 47.9% recibieron NOACs y 32.4% antagonistas de la vitamina K (VKA); 12.0% recibieron agentes antiagregantes plaquetarios y 7.6% no recibieron tratamiento antitrombotico. A 2 anos de seguimiento, el 70.5% permanecieron en dabigatran. Conclusiones: Los datos de la fase 2 del GLORIA-AF demostraron que en FA no valvular, los NOAC han sido ampliamente adoptados en la practica clinica, y fueron mas frecuentemente prescriptos que los VKA.No obstante una gran proporcion de pacientes en todo el mundo permanecieron sin tratamiento EnglishBackground: The Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF)is a multinational, prospective, 3-phase study to establish the safety and efficacy of dabigatran in patients with newly diagnosednonvalvular atrial fibrillation at risk of stroke. Phase II began when dabigatran, the first non-vitamin K antagonist oral anticoagulant(NOAC) became available.Objectives: The aim of this registry was to describe Phase II baseline clinical data in the general population and the 2-year follow-upof patients treated with dabigatran.Methods: Among 15,644 patients enrolled in the study, 15,308 were eligible and 4,873 received dabigatran. Atrial fibrillation characteristics,follow-up findings and concomitant diseases were recorded and analyzed using descriptive statistics.Results: Forty-five percent of eligible patients were women and median age was 71.0 years (interquartile range: 64-78 years). Patientswere from Europe (47.9%), North America (22.2%), Asia (20.1%), Latin America (6.0%), and the Middle East/Africa (3.9%).Most of them had high risk for stroke (CHA2DS2-VASc score ≥2; 86.1%) and 13.9% had moderate risk (CHA2DS2-VASc score=1). In80.3% of cases, patients received oral anticoagulants: 47.9% NOACs and 32.4% vitamin K antagonists (VKAs); 12.0% received antiplateletagents and 7.6% did not receive antithrombotic treatment. At the 2-year follow-up, 70.5% remained on dabigatran.Conclusions: Data from the GLORIA-AF Phase II registry showed that in nonvalvular AF, NOACs have been highly adopted in clinicalpractice, becoming more frequently prescribed than VKAs. Worldwide, however, a large proportion of patients have remainedundertreated.