Two-year follow-up of patients treated with dabigatran for stroke prevention in atrial fibrillation: Global Registry on Long-Term Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF) registry

Am Heart J. 2018 Apr:198:55-63. doi: 10.1016/j.ahj.2017.08.018. Epub 2017 Aug 31.

Abstract

Background and purpose: GLORIA-AF is a large, global, prospective registry program of newly diagnosed atrial fibrillation (AF) patients with ≥1 stroke risk factors. We describe the effectiveness and safety of dabigatran etexilate over 2 years from routine clinical practice in nearly 3000 patients from GLORIA-AF who are newly diagnosed with non-valvular AF and at risk of stroke.

Methods: Consecutive enrollment into phase II of GLORIA-AF was initiated following approval of dabigatran for stroke prevention in non-valvular AF. Within this Phase II, 2937 dabigatran patients completed 2-year follow-up by May 2016 and were eligible for analysis. Patients who took at least 1 dose of dabigatran (n=2932) were used to estimate incidence rates.

Results: Overall incidence rates per 100 person-years of 0.63 (95% confidence interval [CI], 0.42-0.92) for stroke, 1.12 (0.83-1.49) for major bleeding, 0.47 (0.29-0.72) for myocardial infarction, and 2.69 (2.22-3.23) for all-cause death were observed. For patients taking 150 mg dabigatran twice daily (BID), corresponding rates (95% CI) were 0.56 (0.30-0.94), 1.00 (0.64-1.47), 0.48 (0.25-0.83), and 2.07 (1.55-2.72), respectively. For patients taking 110 mg dabigatran BID, event rates (95% CI) were 0.67 (0.33-1.20), 1.16 (0.70-1.80), 0.43 (0.17-0.88), and 3.16 (2.36-4.15).

Conclusions: These global data confirm the sustained safety and effectiveness of dabigatran over 2 years of follow-up, consistent with the results from clinical trials as well as contemporary real-world studies.

What is known: • Non-vitamin K antagonist (VKA) anticoagulants (NOACs) are the preferred therapy for prevention of ischemic stroke based on phase 3 trials, but there is insufficient information on their efficacy and safety in daily practice, based on prospectively collected data.

What is new: • This study shows that in non-valvular AF patient population, with up to 2 years of follow-up, the use of dabigatran led to a low incidence of ischemic stroke, major bleeding, and myocardial infarction in routine clinical care, confirming the sustained safety and effectiveness of dabigatran in clinical practice over 2 years of follow-up.

Trial registration: ClinicalTrials.gov NCT01468701 NCT01671007 NCT01937377.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Antithrombins / therapeutic use*
  • Atrial Fibrillation / complications*
  • Atrial Fibrillation / diagnostic imaging
  • Confidence Intervals
  • Dabigatran / therapeutic use*
  • Drug Administration Schedule
  • Female
  • Follow-Up Studies
  • Global Health
  • Humans
  • Internationality
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Primary Prevention / methods
  • Prospective Studies
  • Registries*
  • Risk Assessment
  • Sex Factors
  • Stroke / etiology
  • Stroke / prevention & control*
  • Survival Analysis
  • Time Factors

Substances

  • Antithrombins
  • Dabigatran

Associated data

  • ClinicalTrials.gov/NCT01468701
  • ClinicalTrials.gov/NCT01671007
  • ClinicalTrials.gov/NCT01937377