Treatment Practices

Key Data:

  • GARFIELD-AF began recruitment at the time of transition from a period dominated by the use of VKAs to prevent AF-related stroke, to a new era in which NOACs present an alternative treatment
    • Treatment practices have changed, with patients initiated on anticoagulation for stroke prevention increasing from 57.4% to 71.1%
    • Use of VKAs and antiplatelets (APs) (combined or not combined) has decreased from 83.4% to 50.6%. NOAC use (with or without APs) has increased from 4.2% to 37.0%
  • GARFIELD-AF data suggest that quality of VKA control recommended by international guidelines is not sufficiently achieved in routine clinical practice, regardless of the type of VKA. In addition, suboptimal VKA control was associated with an increased risk of stroke/systemic embolism, major bleeding and all-cause mortality
  • Clinical assessment of the quality of VKA control at the patient level may change considerably if frequency in range (FIR) is used instead of time in therapeutic range (TTR)
    • On average, FIR increased as TTR increased; however, in a group of patients with a TTR of 70–80%, 25% had an FIR of less than 57.1%
    • FIR and TTR are not equivalent and cannot be used interchangeably. FIR gives a lower value than TTR overall. The difference between FIR and TTR explained 17.4% of the total variability of measurements
  • Newly diagnosed patients with AF are more frequently receiving guideline-recommended therapy. GARFIELD-AF shows that antithrombotic treatment is suboptimal in many patients
    • Since 2010, there has been an increase in newly diagnosed patients with AF at risk of stroke receiving guideline-recommended therapy, predominantly driven by increased use of NOACs and reduced use of VKAs ± AP therapy or AP therapy alone
    • Most patients with a high risk of stroke (CHA2DS2-VASc ≥2) receive anticoagulant therapy, and this proportion increased over time, largely driven by NOAC prescribing
    • Approximately 1 in 10 patients receive no antithrombotic treatment. There has been no change in the proportion of patients that receive no antithrombotic treatment, including apparently eligible patients at high stroke risk and low bleeding risk

Key Publications:

Related Publications

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27 Jun 17

Global status

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Total patients 57,262
Recruitment Recruitment closed
Follow-up Ongoing
Study end: 2018

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To find out more about GARFIELD-AF, please contact the Thrombosis Research Institute

E: garfield@tri-london.ac.uk
T: 0203 198 9947