Huisman Menno V, Ma Chang Sheng, Diener Hans-Christoph, Dubner Sergio J, Halperin Jonathan L, Rothman Kenneth J, Teutsch Christine, Schoof Nils, Kleine Eva, Bartels Dorothee B, Lip Gregory Y H
Department of Thrombosis and Hemostasis, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
Cardiology Department, Atrial Fibrillation Center, Beijing AnZhen Hospital, Capital Medical University, Beijing, China.
Europace. 2016 Sep;18(9):1308-18. doi: 10.1093/europace/euw073. Epub 2016 Jun 21.
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.
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.
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.
非维生素K拮抗剂口服抗凝药（NOACs）与早期的维生素K拮抗剂（VKA）治疗不同，其引入改变了心房颤动（AF）的卒中预防方法。GLORIA-AF是一项前瞻性全球注册项目，描述了新诊断的有卒中风险的AF患者抗栓治疗的选择。它包括三个阶段：第一阶段，在NOACs引入之前；第二阶段，在首个NOAC达比加群引入期间；第三阶段，在NOACs已在临床实践中确立之后。
在第一阶段，1100名入组患者中有1063名符合条件（男性占54.3%；中位年龄70岁）；患者来自中国（67.1%）、欧洲（欧盟；27.4%）和中东（5.6%）。大多数使用VKA的患者有高卒中风险（CHA2DS2-VASc≥2；86.5%）；13.5%有中度风险（CHA2DS2-VASc = 1）。持续性/永久性AF患者使用维生素K拮抗剂的比例（47.7%）高于阵发性AF患者（23.9%）。中国大多数患者接受抗血小板药物治疗（53.7%），而欧盟为27.1%，中东为28.8%。在中国，25.9%的患者未接受抗栓治疗，而欧盟为8.6%，中东为8.5%。
GLORIA-AF的第一阶段表明，VKA主要用于持续性/永久性（与阵发性相对）AF患者以及有高卒中风险的患者。此外，在NOACs可用之前的时代，VKA治疗的使用存在显著的地域差异，包括在中国VKA的使用要低得多，在中国大多数患者要么接受抗血小板药物治疗，要么未接受抗栓治疗。
