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

Fauchier, Laurent, Greenlaw, Nicola, Ferrari, Roberto, Ford, Ian, Fox, Kim M., Tardif, Jean-Claude, Tendera, Michal, Steg, Ph. Gabriel, CLARIFY Investigators and Colquhoun, D. M. (2015) Use of anticoagulants and antiplatelet agents in stable outpatients with coronary artery disease and atrial fibrillation. International CLARIFY registry. PLoS ONE, 10 4: . doi:10.1371/journal.pone.0125164


Author Fauchier, Laurent
Greenlaw, Nicola
Ferrari, Roberto
Ford, Ian
Fox, Kim M.
Tardif, Jean-Claude
Tendera, Michal
Steg, Ph. Gabriel
CLARIFY Investigators
Colquhoun, D. M.
Title Use of anticoagulants and antiplatelet agents in stable outpatients with coronary artery disease and atrial fibrillation. International CLARIFY registry
Journal name PLoS ONE   Check publisher's open access policy
ISSN 1932-6203
Publication date 2015-04-27
Sub-type Article (original research)
DOI 10.1371/journal.pone.0125164
Open Access Status DOI
Volume 10
Issue 4
Total pages 23
Place of publication San Francisco, United States
Publisher Public Library of Science
Collection year 2016
Language eng
Formatted 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.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Non HERDC
School of Medicine Publications
 
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