In higher-risk patients with atrial fibrillation (AF), treatment with non-vitamin K antagonist oral anticoagulants (NOACs) significantly reduced 2-year mortality compared to those treated with vitamin K antagonists (VKAs), according to findings from a new analysis of a large, multinational, prospective AF registry. 

The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is a worldwide observational program that includes 57,262 patients newly diagnosed with newly diagnosed nonvalvular AF and with ≥1 risk factor for stroke. The new analysis – presented at the ESC Congress 2018 – included 19,134 of these patients and showed that there were 19% fewer deaths in patients started on NOACs vs VKAs at the time of AF diagnosis (adjusted hazard ratio [HR] 0.81, 95% CI, 0.71, 0.92; <.001).

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Additional data of higher-risk patients (CHA2DS2-VASc score ≥2) in the GARFIELD-AF registry (N=26,742) showed there were 17% fewer deaths (HR 0.83, 95% CI, 0.75, 0.93; <.001) and 27% fewer strokes/systemic emboli (HR 0.73, 95% CI, 0.59, 0.90; =.003) when treated with anticoagulants (AC) vs those receiving no AC therapy. 

Among patients with new onset AF and no prior antiplatelet (AP) or AC use, treatment with both AC+AP had a higher risk of major bleeding (HR 1.45, 95% CI, 0.94, 2.23) and all-cause mortality (HR 1.31, 95% CI, 1.05, 1.62) without a reduction in stroke (HR 1.60, 95% CI, 1.08, 2.35), when compared with AC alone.

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