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Global AF registry presents
two-year outcomes data
Pharmacists should be alert for people being prescribed lower than
the recommended doses of blood thinning medicines, according to the
Principal Investigator of GARFIELD Australia, Dr Harry Gibbs.
Speaking at a media briefing in Sydney
last month about the outcomes from
the first two years from the Global
Anticoagulant Registry in the Field
– Atrial Fibrillation (GARFIELD-AF)
Dr Gibbs, who is Medical Director of
the Vascular Laboratory at The Alfred
Hospital in Melbourne, said he sensed
that doctors were worried about
the effects of NOACs (non-vitamin K
antagonist oral anticoagulants) and
were prescribing low doses.
He said they should not do this, as
would affect the results. The clinical
trials for these medicines had been
conducted using specific doses that
should be adhered to, as there was no
evidence one way or the other about the
effect of using a lower dose.
GARFIELD-AF is an independent
academic research initiative, led by
an international steering committee
under the auspices of the Thrombosis
Research Institute (TRI) in London.
It is an international observational,
multicentre study of patients with newly
The two-year outcomes of GARFIELD-AF
found that all-cause death was the most
frequent major event in more than
17,000 newly diagnosed AF patients, far
exceeding the rate of stroke or major
bleeding. These two-year prospective
outcomes from cohorts 1 and 2 showed
a mortality rate of 3.83% per person year
compared with stroke rates of 1.25% per
person-year and major bleeding rates of
0.70% per person-year.
Additional one-year outcomes from
more than 28,000 AF patients in cohorts
1–3 demonstrated a likely impact of
comorbidities on increasing mortality,
stroke and major bleeding. Patients with
moderate-to-severe chronic kidney
disease and those with a history of
myocardial infarction had a markedly
higher mortality rate than the overall
population (9.4% and 6.9% respectively,
compared with 4.0%).
Insights from nearly 40,000 patients
with AF across the four sequential
GARFIELD-AF cohorts from 2010 to
2015 showed a shift in how AF is being
managed across the globe. Overall,
patients initiated on anticoagulant
treatment for stroke prevention
increased from 57.4% to 71.1%. Use of
vitamin K antagonists (VKAs) and
antiplatelets (combined or alone)
fell from 83.4% to 50.6%, whilst use of
NOACs with or without an antiplatelet
increased from 4.1% to 37.0%.
In a media statement about the
results, Professor of Surgery at
University College London and
Director of the Thrombosis Research
Institute, Professor Ajay Kakkar, said:
‘ This evolution in treatment patterns
is consistent with the adoption
of innovative therapies for stroke
prevention. The remaining challenge,
however, is to ensure that the correct
patient receives the appropriate therapy.’
The study will follow 57,000 patients
from at least 1,000 centres in
35 countries including Australia.
Nearly 45,000 patients were recruited
in four sequential cohorts between
December 2009 and July 2015. The fifth
and final cohort began recruiting
at the beginning of August 2015.
It seeks to provide insights into the
impact of anticoagulant therapy
on thromboembolic and bleeding
GARFIELD-AF has 20 clinicians actively
involved in the Australian arm of
GARFIELD-AF, with 813 currently
enrolled patients based in Australia.
As one of the first countries to enrol
patients in the GARFIELD-AF Registry,
there have now been two data cohorts
running in Australia for a sufficient time
period to allow follow-up, providing an
opportunity to view how prescribing
patterns and treatment behaviours in
Australia have been affected by the
introduction of NOACs.
1. Kakkar AJ. Anticoagulation and AF: real life data from the
GARFIELD-AF registry. Symposium conducted at ESC
Congress, Aug 2015, London, United Kingdom.
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