title: Antithrombotic therapy use in patients with atrial fibrillation before the era of non-vitamin K antagonist oral anticoagulants: the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF) Phase I cohort.
abstract: OBJECTIVE
  The introduction of non-VKA oral anticoagulants (NOACs), which differ from the earlier vitamin K antagonist (VKA) treatments, has changed the approach to stroke prevention in atrial fibrillation (AF). GLORIA-AF is a prospective, global registry programme describing the selection of antithrombotic treatment in newly diagnosed AF patients at risk of stroke. It comprises three phases: Phase I, before the introduction of NOACs; Phase II, during the time of the introduction of dabigatran, the first NOAC; and Phase III, once NOACs have been established in clinical practice.
  
  
  RESULTS
  In Phase I, 1063 patients were eligible from the 1100 enrolled (54.3% male; median age 70 years); patients were from China (67.1%), Europe (EU; 27.4%), and the Middle East (ME; 5.6%). The majority of patients using VKAs had high stroke risk (CHA2DS2-VASc ≥ 2; 86.5%); 13.5% had moderate risk (CHA2DS2-VASc = 1). Vitamin K antagonist use was higher for persistent/permanent AF (47.7%) than that for paroxysmal (23.9%). Most patients in China were treated with antiplatelet agents (53.7%) vs. 27.1% in EU and 28.8% in ME. In China, 25.9% of patients had no antithrombotic therapy, vs. 8.6% in EU and 8.5% in ME.
  
  
  CONCLUSIONS
  Phase I of GLORIA-AF shows that VKAs were mostly used in patients with persistent/permanent (vs. paroxysmal) AF and in those with high stroke risk. Furthermore, there were meaningful geographical differences in the use of VKA therapy in the era before the availability of NOACs, including a much lower use of VKAs in China, where most patients either received antiplatelet agents or no antithrombotic treatment.
authors.affiliation: Department of Thrombosis and Hemostasis, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands m.v.huisman@lumc.nl.
authors.forename: Menno V
authors.initials: MV
authors.lastname: Huisman
authors.affiliation: Cardiology Department, Atrial Fibrillation Center, Beijing AnZhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Chang Sheng
authors.initials: CS
authors.lastname: Ma
authors.affiliation: Department of Neurology and Stroke Center, University Hospital of Essen (Ruhr), Essen, Germany.
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Diener
authors.affiliation: Clinica y Maternidad Suizo Argentina, Buenos Aires, Argentina.
authors.forename: Sergio J
authors.initials: SJ
authors.lastname: Dubner
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Halperin
authors.affiliation: RTI Health Solutions, Research Triangle Institute, Research Triangle Park, Durham, NC, USA.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Rothman
authors.affiliation: Medicine TA Cardiology, Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Teutsch
authors.affiliation: Corporate Department Global Epidemiology, Boehringer Ingelheim GmbH, Ingelheim am Rhein, Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Schoof
authors.affiliation: Global Biometrics and Clinical Applications, Boehringer Ingelheim GmbH, Ingelheim am Rhein, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Kleine
authors.affiliation: Corporate Department Global Epidemiology, Boehringer Ingelheim GmbH, Ingelheim am Rhein, Germany Institute of Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany.
authors.forename: Dorothee B
authors.initials: DB
authors.lastname: Bartels
authors.affiliation: Centre for Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D001777:Blood Coagulation / Q000187:drug effects*; D002681:China; D004334:Drug Administration Schedule; D005060:Europe; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D054625:Healthcare Disparities / Q000639:trends*; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D008877:Middle East; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000175:diagnosis / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D014812:Vitamin K / Q000037:antagonists & inhibitors* / Q000097:blood
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D014812:Vitamin K
keywords: Atrial fibrillation; Oral anticoagulation; Registry; Stroke