Characteristics of patients with atrial fibrillation prescribed antiplatelet monotherapy compared with those on anticoagulants: insights from the GARFIELD-AF registry

Freek W A Verheugt, Haiyan Gao, Wael Al Mahmeed, Giuseppe Ambrosio, Pantep Angchaisuksiri, Dan Atar, Jean-Pierre Bassand, A John Camm, Frank Cools, John Eikelboom, Gloria Kayani, Toon Wei Lim, Frank Misselwitz, Karen S Pieper, Martin van Eickels, Ajay K Kakkar,
European Heart Journal. 2017-12-20; 39(6): 464-473

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1. Eur Heart J. 2018 Feb 7;39(6):464-473. doi: 10.1093/eurheartj/ehx730.

Characteristics of patients with atrial fibrillation prescribed antiplatelet
monotherapy compared with those on anticoagulants: insights from the GARFIELD-AF

Verheugt FWA(1), Gao H(2), Al Mahmeed W(3), Ambrosio G(4), Angchaisuksiri P(5),
Atar D(6), Bassand JP(2)(7), Camm AJ(8), Cools F(9), Eikelboom J(10), Kayani
G(2), Lim TW(11), Misselwitz F(12), Pieper KS(13), van Eickels M(14), Kakkar
AK(2)(15); GARFIELD-AF Investigators.

Author information:
(1)Department of Cardiology, Onze Lieve Vrouwe Gasthuis (OLVG), Oosterpark 9,
1091 AC Amsterdam, The Netherlands.
(2)Thrombosis Research Institute, Emmanuel Kaye Building, Manresa Road, London
SW3 6LR, UK.
(3)Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland
Clinic Abu Dhabi, Al Falah Street, Al Maryah Island, Abu Dhabi, UAE.
(4)Division of Cardiology, University of Perugia School of Medicine Cardiology,
Via S. Andrea delle Fratte, 06126 Perugia, Italy.
(5)Department of Medicine, Division of Hematology, Ramathibodi Hospital, Mahidol
University, 270 Rama VI Road, Bangkok 10400, Thailand.
(6)Department of Cardiology B, Oslo University Hospital Ullevål, and Faculty of
Medicine, University of Oslo, Kirkeveien 166, N-0407 Oslo, Norway.
(7)Department of Cardiology EA 3920, University of Besançon, Besançon, France.
(8)Cardiovascular and Cell Sciences Research Institute, St. George’s University
of London, Cranmer Terrace, London SW17 0RE, UK.
(9)AZ Klina, Augustijnslei 100, 2930 Brasschaat, Belgium.
(10)Population Health Research Institute, 237 Barton Street East, Hamilton, ON
L8L 2X2, Canada.
(11)National University Heart Centre, National University Hospital, 1E Kent Ridge
Road, NUHS Tower Block, Level 9, Singapore 119228.
(12)Pharmaceuticals Division, Bayer Pharma AG, Therapeutic Area General Medicine,
Aprather Weg 18a, 42113 Wuppertal, Germany.
(13)Duke Clinical Research Institute, 2400 Pratt Street, Rm 0311 Terrace Level,
Durham, NC 27705, USA.
(14)Medical Affairs & Pharmacovigilance, Pharmaceuticals, MA TA Thrombosis &
Ophthalmology, Bayer AG, Building S101, S101 4.134, 13342 Berlin, Germany.
(15)University College London, Gower Street, Bloomsbury, London WC1E 6BT, UK.

Comment in
Eur Heart J. 2018 Feb 7;39(6):474-476.

Aims: Current atrial fibrillation (AF) guidelines discourage antiplatelet (AP)
monotherapy as alternative to anticoagulants (ACs). Why AP only is still used is
largely unknown.
Methods and results: Factors associated with AP monotherapy prescription were
analysed in GARFIELD-AF, a registry of patients with newly diagnosed (≤6 weeks)
AF and ≥1 investigator-determined stroke risk factor. We analysed 51 270 patients
from 35 countries enrolled into five sequential cohorts between 2010 and 2016.
Overall, 20.7% of patients received AP monotherapy, 52.1% AC monotherapy, and
14.1% AP + AC. Most AP monotherapy (82.5%) and AC monotherapy (86.8%) patients
were CHA2DS2-VASc ≥2. Compared with patients on AC monotherapy, AP monotherapy
patients were frequently Chinese (vs. Caucasian, odds ratio 2.73) and more likely
to have persistent AF (1.32), history of coronary artery disease (2.41) or other
vascular disease (1.67), bleeding (2.11), or dementia (1.81). The odds for AP
monotherapy increased with 5 years of age increments for patients ≥75 years
(1.24) but decreased with age increments for patients 55-75 years (0.86).
Antiplatelet monotherapy patients were less likely to have paroxysmal (0.67) or
permanent AF (0.57), history of embolism (0.56), or alcohol use (0.90). With each
cohort, AP monotherapy declined (P

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