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

PLoS One. 2015 Apr 27;10(4):e0125164. doi: 10.1371/journal.pone.0125164. eCollection 2015.

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.

Trial registration: ISRCTN registry of clinical trials: ISRCTN43070564.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Anticoagulants / administration & dosage
  • Anticoagulants / therapeutic use*
  • Atrial Fibrillation / drug therapy*
  • Cohort Studies
  • Coronary Artery Disease / drug therapy*
  • Drug Therapy, Combination
  • Female
  • Guideline Adherence / statistics & numerical data
  • Humans
  • Male
  • Outpatients / statistics & numerical data
  • Platelet Aggregation Inhibitors / administration & dosage
  • Platelet Aggregation Inhibitors / therapeutic use*
  • Practice Patterns, Physicians' / statistics & numerical data
  • Registries

Substances

  • Anticoagulants
  • Platelet Aggregation Inhibitors

Associated data

  • ISRCTN/ISRCTN43070564

Grant support

The study was designed and conducted by the investigators and funded via research grants from Servier, France, including a grant to the academic statistical centre. The sponsor provided assistance for study set-up and management in each country, and funded editorial assistance in the preparation of the manuscript, tables, and figures. The sponsor was sent the manuscript before submission. Data collection was performed via an electronic case record form; all data analysis was conducted by an independent academic data statistics center. The funder did not have any additional role in the study design, data collection and analysis, or preparation of the manuscript.