Leiden University Medical Center, Leiden, The Netherlands.
RTI Health Solutions, Research Triangle Institute, Research Triangle Park, NC.
Am J Med. 2015 Dec;128(12):1306-13.e1. doi: 10.1016/j.amjmed.2015.07.013. Epub 2015 Aug 1.
The Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF) was designed to provide prospectively collected information on patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke, with the aim of addressing treatment patterns and questions of effectiveness and safety.
In this predefined analysis from GLORIA-AF, the baseline characteristics and initial antithrombotic management of the first 10,000 patients in Phase II of this large Registry Program are presented. Overall, 32.3% of patients received vitamin K antagonists (VKAs) and 47.7% received non-VKA oral anticoagulants (NOACs), while 12.3% received antiplatelet treatment and 7.6% did not receive any antithrombotic treatment. Among patients with CHA2DS2-VASc score ≥2, 6.7% received no antithrombotic treatment and 10.0% received aspirin. In Europe, treatment with dabigatran was as common as treatment with VKAs (38.8% and 37.8%, respectively). More than half of the patients were treated with NOACs (52.4%), while antiplatelet treatment was given to 5.7%, and 4.1% did not receive any antithrombotic treatment. In North America, treatment with dabigatran (25.0%) was as common as with VKAs (26.1%), but overall NOAC use was more common (52.1%) than with VKAs (26.1%); however, 14.1% received antiplatelet treatment, while 7.6% received no antithrombotic treatment. In Asia, treatment with VKAs (31.9%) was more prevalent than NOACs (25.5%), but antiplatelet treatment was given to 25.8%, and 16.9% did not receive any antithrombotic treatment. In Asia, only 60.7% of patients with high stroke risk received oral anticoagulants (OACs). Paroxysmal atrial fibrillation and minimally symptomatic (or asymptomatic) patients were often undertreated with OACs.
In this analysis, OAC use was high in Europe and North America, with overall NOAC use higher than VKA use. A considerable percentage of high-risk patients in North America still received antiplatelet treatment or were untreated, while Asian patients had a high proportion of aspirin use and nontreatment.
全球心房颤动患者长期口服抗栓治疗注册研究（GLORIA-AF）旨在提供新诊断为非瓣膜性心房颤动且有卒中风险患者的前瞻性资料，旨在解决治疗模式及有效性和安全性问题。
本研究为 GLORIA-AF 的预先设定分析，纳入了该大型注册研究项目第二阶段前 10000 例患者的基线特征和初始抗栓治疗情况。整体而言，32.3%的患者接受维生素 K 拮抗剂（VKA）治疗，47.7%接受非 VKA 口服抗凝剂（NOAC）治疗，12.3%接受抗血小板治疗，7.6%未接受任何抗栓治疗。CHA2DS2-VASc 评分≥2 分的患者中，6.7%未接受抗栓治疗，10.0%接受阿司匹林治疗。在欧洲，达比加群的使用率与 VKA 相当（分别为 38.8%和 37.8%）。超过一半的患者接受了 NOAC 治疗（52.4%），而接受抗血小板治疗的患者占 5.7%，4.1%未接受任何抗栓治疗。在北美，达比加群的使用率（25.0%）与 VKA 相当（26.1%），但总体上 NOAC 的使用率（52.1%）高于 VKA（26.1%）；然而，14.1%的患者接受了抗血小板治疗，7.6%未接受抗栓治疗。在亚洲，VKA（31.9%）的使用率高于 NOAC（25.5%），但抗血小板治疗的使用率为 25.8%，16.9%未接受任何抗栓治疗。在亚洲，仅有 60.7%的高危卒中患者接受了口服抗凝剂（OAC）治疗。阵发性心房颤动和症状轻微（或无症状）的患者通常 OAC 治疗不足。
本分析中，欧洲和北美地区 OAC 的使用率较高，总体上 NOAC 的使用率高于 VKA。在北美，仍有相当比例的高危患者接受抗血小板治疗或未接受治疗，而亚洲患者则有较高比例的阿司匹林使用率和未治疗率。
