Stroke prevention in atrial fibrillation changes after dabigatran availability in China: The GLORIA‐AF registry

Journal of Arrhythmia, vol. 36, pp. 408–416

Abstract

BACKGROUND: Until the approval of dabigatran etexilate, treatment choices for stroke prevention in patients with atrial fibrillation (AF) were vitamin K antagonists (VKAs) or antiplatelet drugs. This analysis explored whether availability of non-vitamin K antagonist oral anticoagulants post-dabigatran approval was associated with changing treatment patterns in China. METHODS: Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF) collected data on antithrombotic therapy choices for patients with newly diagnosed nonvalvular AF at risk for stroke. In China, enrollment in phase 1 (before dabigatran approval) and phase 2 (after dabigatran approval) occurred from 2011 to 2013 and 2013 to 2014, respectively. Analyses were restricted to sites within China that contributed patients to both phases. The weighted average of the site-specific results was estimated for standardization. Sensitivity analyses used multiple regression. RESULTS: -VASc ≥2) and bleeding (HAS-BLED ≥3); 55.5% were male. In phase 1, 16.7%, 61.6%, and 21.7% of patients were prescribed oral anticoagulants (OACs), antiplatelet agents, and no treatment, respectively. Respective proportions were 26.4%, 40.6%, and 33.0% in phase 2. The absolute increase in the site-standardized proportion of patients prescribed OACs after dabigatran availability was 9.9% (95% confidence interval [CI]: 3.7%-16.0%). There was a standardized 17.3% (95% CI: -24.3% to -10.4%) absolute decrease in antiplatelet agent use. CONCLUSIONS: There was an increase in OAC and decrease in antiplatelet agent prescription since dabigatran availability in China. However, a large proportion of AF patients at risk for stroke remained untreated.

Authors 12

1. Changsheng Ma corresponding

   Capital Medical University · Beijing Anzhen Hospital

   Affiliation as printed

   Cardiology Department Atrial Fibrillation Center Beijing Anzhen Hospital Capital Medical University Beijing China

   Cardiology Department, Atrial Fibrillation Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China

2. Lionel Riou França

   Sanofi (France)

   Affiliation as printed

   Sanofi‐Aventis Recherche et Développement Chilly‐Mazarin France

3. Shihai Lu

   Boehringer Ingelheim (United States)

   Affiliation as printed

   Biostatistics and Data Sciences Department Boehringer Ingelheim Pharmaceuticals, Inc. Ridgefield CT USA

   Biostatistics and Data Sciences Department, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA

4. Hans‐Christoph Diener

   University of Duisburg-Essen

   Affiliation as printed

   Department of Neurology University of Duisburg‐Essen Essen Germany

   Department of Neurology, University of Duisburg-Essen, Essen, Germany

5. Sérgio Dubner
   Affiliation as printed

   Clínica y Maternidad Suizo Argentina Buenos Aires Argentina

6. Jonathan L. Halperin

   Icahn School of Medicine at Mount Sinai

   Affiliation as printed

   Icahn School of Medicine at Mount Sinai New York NY USA

   Icahn School of Medicine at Mount Sinai, New York, NY, USA

7. Qiang Li

   Boehringer Ingelheim (China)

   Affiliation as printed

   Boehringer Ingelheim (China) Investment Co. Ltd. Beijing China

   Boehringer Ingelheim (China) Investment Co. Ltd., Beijing, China

8. Miney Paquette

   Boehringer Ingelheim (Canada)

   Affiliation as printed

   Department of Medicine Boehringer Ingelheim Burlington ON Canada

   Department of Medicine, Boehringer Ingelheim, Burlington, ON, Canada

9. Christine Teutsch

   Sanofi (France)

   Affiliation as printed

   Sanofi‐Aventis Recherche et Développement Chilly‐Mazarin France

10. Menno Volkert Huisman Aachen Department of Thrombosis and Hemostasis Leiden University Medical Center Leiden The Netherlands Department of Thrombosis and Hemostasis

    Leiden University Medical Center

    Affiliation as printed

    Department of Thrombosis and Hemostasis Leiden University Medical Center Leiden the Netherlands

    Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands

11. Gregory Y.H. Lip

    University of Liverpool · Liverpool Heart and Chest Hospital · Aalborg University

    Affiliation as printed

    Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark

    Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK

    Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

12. Kenneth Jay Rothman

    RTI International · RTI Health Solutions

    Affiliation as printed

    RTI Health Solutions Research Triangle Institute Research Triangle Park NC USA

    RTI Health Solutions, Research Triangle Institute, Research Triangle Park, NC, USA