Introduction: Given their substantial risk of recurrent stroke, patients with atrial fibrillation (AF) and prior stroke are at highest risk. Such patients should be pre-scribed oral anticoagulants (OAC), either a Vitamin K Antagonist (VKA) or Non-VKA OAC (NOAC).
Methods: Using an inception cohort design, GLORIA-AF collected data on choice of antithrombotic therapy for patients with newly identified AF at risk of stroke (CHA2DS2VASc scores ≥ 1) in the course of routine care. We examined the use of an-tithrombotic therapy in those with prior stroke.
Results: From 15,092 patients in Phase II of GLORIA-AF enrolled in 5 geographical regions worldwide (Europe, North America, Asia, Latin America and Africa/Middle East), 1,582 patients (median age 75 years, 54.9% male) had previous stroke, with a median CHA2DS2-VASc score of 5, compared with a score of 3 in those without previ-ous stroke (n=13,500). For 10 patients previos stroke status was unknown.
In those with previous stroke, VKA alone was prescribed in 25.2%, VKA plus an-tiplatelet therapy (AP) in 5.8%, NOAC alone in 42.9%, NOAC plus AP in 7.7%, and AP alone in 12.1%; 6.3% received no antithrombotic therapy. Proportions were broadly similar in males and females. In comparison, among patients without prior stroke the proportions on AP only or no therapy were a little higher (20.2 versus 18.3%). Among those with prior stroke, proportions on AP alone in Asia, Europe, and North America were 24.2, 9.9 and 5.6% respectively, while proportions on no antithrombotic therapy in these regions were 16.3, 3.2 and 4.5%.
Conclusion: In this prospective registry, AF patients with prior stroke and a median CHA2DS2-VASc score of 5, approximately 18% were treated with AP alone or no an-tithrombotic therapy, and the treatment gap was greater in Asia than in Europe or North America.