Use of Anticoagulants and Antiplatelet Agents in Stable Outpatients with Coronary Artery Disease and Atrial Fibrillation. International CLARIFY Registry

• Published in: PloS one Vol. 10; no. 4; p. e0125164
• Main Authors: Fauchier, Laurent, Greenlaw, Nicola, Ferrari, Roberto, Ford, Ian, Fox, Kim M, Tardif, Jean-Claude, Tendera, Michal, Steg, Ph Gabriel
• Format: Journal Article Web Resource
• Language: English
• Published: United States Public Library of Science 27.04.2015; Public Library of Science (PLoS)
• Subjects: Aged; Angina; Anticoagulants; Anticoagulants - administration & dosage; Anticoagulants - therapeutic use; Atrial Fibrillation; Atrial Fibrillation - drug therapy; Balloon angioplasty; Cardiac patients; Cardiovascular & respiratory systems; Cardiovascular agents; Cerebral infarction; Clinical trials; Cohort Studies; Coronary artery; Coronary Artery Disease; Coronary Artery Disease - drug therapy; Data processing; Drug Therapy, Combination; Drugs; Female; Fibrillation; Guideline Adherence; Guideline Adherence - statistics & numerical data; Heart; Heart attack; Heart diseases; Human health sciences; Humanities and Social Sciences; Humans; Infarction; Ischemia; Male; Medical ethics; Medical research; Myocardial infarction; Myocardial ischemia; Outpatients; Outpatients - statistics & numerical data; Pain; Patients; Platelet Aggregation Inhibitors; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - therapeutic use; Practice Patterns, Physicians; Practice Patterns, Physicians' - statistics & numerical data; Registries; Sciences de la santé humaine; Stenosis; Stroke; Systèmes cardiovasculaire & respiratoire; Therapy; Ventricle
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0125164

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. 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. 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. ISRCTN registry of clinical trials: ISRCTN43070564.