Use of anticoagulants and antiplatelet agents in stable outpatients with coronary artery disease and atrial fibrillation. International CLARIFY registry

CLARIFY Investigators

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19 Citations (Scopus)

Abstract

Background Few data are available regarding the use of antithrombotic strategies in coronary artery disease patients with atrial fibrillation (AF) in everyday practice. We sought to describe the prevalence of AF and its antithrombotic management in a contemporary population of patients with stable coronary artery disease. Methods and Findings CLARIFY is an international, prospective, longitudinal registry of outpatients with stable coronary artery disease, defined as prior (≥12 months) myocardial infarction, revascularization procedure, coronary stenosis >50%, or chest pain associated with evidence of myocardial ischemia. Overall, 33,428 patients were screened, of whom 32,954 had data available for analysis at baseline; of these 2,229 (6.7%) had a history of AF. Median (interquartile range) CHA2DS2-VASc score was 4 (3, 5). Oral anticoagulation alone was used in 25.7%, antiplatelet therapy alone in 52.8% (single 41.8%, dual 11.0%), and both in 21.5%. OAC use was independently associated with permanent AF (p<0.001), CHA2DS2-VASc score (p=0.006), pacemaker (p<0.001), stroke (p=0.04), absence of angina (p=0.004), decreased left ventricular ejection fraction (p<0.001), increased waist circumference (p=0.005), and longer history of coronary artery disease (p=0.008). History of percutaneous coronary intervention (p=0.004) and no/partial reimbursement for cardiovascular medication (p=0.01, p<0.001, respectively) were associated with reduced oral anticoagulant use. Conclusions In this contemporary cohort of patients with stable coronary artery disease and AF, most of whom are theoretical candidates for anticoagulation, oral anticoagulants were used in only 47.2%. Half of the patients received antiplatelet therapy alone and one-fifth received both antiplatelets and oral anticoagulants. Efforts are needed to improve adherence to guidelines in these patients.

Original languageEnglish
Article numbere0125164
JournalPloS one
Volume10
Issue number4
DOIs
Publication statusPublished - 2015

Bibliographical note

Funding Information:
This study was funded via research grants from Servier. Editorial support was provided by Sophie Rushton-Smith, PhD (MedLink Healthcare Communications). Dr. Fauchier reports consultancy fees/honoraria from Bayer, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb-Pfizer alliance, Medtronic, Novartis, Sanofi, and Servier. Ms Greenlaw reports no relationships. Dr. Ferrari reports Speaker’s bureau for Servier, Roche, Boehringer Ingelheim; research grants from Servier, Boehringer Ingelheim and Roche; and advisory board for Servier, Bayer, Roche and Boehringer Ingelheim. Dr Ford reports research grants, honoraria for committee membership, and support for conference attendance from Servier. Dr. Fox reports fees, honoraria, and research grants from Servier. Dr. Tarif reports research grants and honoraria from Servier. Dr. Tendera reports fees, honoraria, and research grants from Amgen, Bayer, Menarini, Servier and TIMI Group. Dr. Steg reports research grants from Servier; consultancy fees/honoraria from Amgen, Astellas, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo/Eli Lilly alliance, Eisai, GlaxoSmithKline, Medtronic, Merck Sharpe and Dohme, Pfizer, Roche, Sanofi, Servier, and The Medicines Company; and equity ownership in Aterovax. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Publisher Copyright:
© 2015 Fauchier et al.

All Science Journal Classification (ASJC) codes

  • General

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