Improved Outcomes With Guideline-Adherent Antithrombotic Treatment in High-Risk AFib Patients

Patients with atrial fibrillation (AFib) who receive antithrombotic management in accordance with the European Society of Cardiology (ESC) guidelines have better outcomes than those who do not, according to one-year follow-up results from the ESC’s EORP-AF Pilot General Registry presented Aug. 30 at ESC Congress 2015 in London.

Study investigators analyzed one-year follow-up data from 2,460 patients enrolled in the registry and identified as at high risk of stroke to gauge whether they received antithrombotic therapy management that adhered to ESC guidelines, or whether they were over-treated or under-treated. The endpoint of any thromboembolism was defined as stroke, transient ischemic attack, acute coronary syndrome, coronary intervention, cardiac arrest, peripheral embolism and pulmonary embolism. Investigators also looked at differences in characteristics between guideline-adherent, over-treated or under-treated high-risk patients and the associated adverse outcomes at one year.

Results showed 60.6 percent of high-risk AFib patients received guideline-adherent treatment, while 17.3 percent of patients were under-treated and 21.7 percent were over-treated. High-risk patients who received guideline-adherent antithrombotic treatment had significantly lower rates of major adverse events during one-year follow up than over- or under-treated patients. Guideline-adherent patients had a 3.2 percent rate of "any thromboembolism," compared to 5.1 percent and 6.0 percent in the under- and over-treated patients, respectively (p=0.0259).

Significantly lower rates of the composite endpoints of "all cause death and any thromboembolism" and "cardiovascular death, any thromboembolism or bleeding" were also observed in the guideline-adherent group. Investigators also noted the endpoint of "all cause death and any thromboembolism" increased by more than 60 percent in under-treated and over-treated patients compared to those receiving guideline adherent therapy. Under-treatment increased risk of "cardiovascular death, any thromboembolism or bleeding" by more than 70 percent.

"This is the first study to show better outcomes using the 2012 ESC guidelines on AFib," said principal investigator Gregory YH Lip, MD, FACC, from the University of Birmingham, UK, and Aalborg University, Denmark. "The results … reveal that inappropriate use of oral anticoagulation can be harmful, with a more than 60 percent increase in all cause death and any thromboembolism in patients who were under- or over-treated."

Moving forward, Lip said that stroke prevention is central to AFib management. "Our analysis emphasizes the importance of adhering to oral anticoagulation guidelines, which reduce stroke and save lives. Furthermore, we have shown that the CHA2DS2-VASc risk based approach to identifying patients for antithrombotic therapy … works well and guidelines adherence translates to improved outcomes."

Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Acute Coronary Syndrome, Atrial Fibrillation, Fibrinolytic Agents, Heart Arrest, Hemorrhage, Ischemic Attack, Transient, Lip, Pulmonary Embolism, Registries, Research Personnel, Stroke, Thromboembolism, ESC Congress

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