Middle East Treatment Strategies and Clinical Outcomes in Patients with Atrial Fibrillation: One-Year Follow-up Data from Garfield-AF Study

INTRODUCTION

The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) aims to determine real-life treatment patterns and clinical outcomes of patients with newly diagnosed non-valvular atrial fibrillation (AF) and at least one investigator-determined risk factor for stroke. The registry includes a wide array of baseline characteristics and has a particular focus on: (1) bleeding and thromboembolic events; (2) international normalized ratio fluctuations; and (3) therapy compliance and persistence patterns.

METHODS

Evolution in baseline treatment for patients enrolled in sequential cohorts showed an increase in prescribing of novel oral anticoagulants over time. Variability in novel oral anticoagulant prescription is primarily due to differences in availability of treatment and prescribing habits between countries and care settings. The GARFIELD-AF registry also provides insights into clinical management and related outcomes of AF in Middle East populations.

RESULTS

A total of 1660 patients with non-valvular AF (median age 64.0 years, interquartile range 56.0-72.0), mostly diagnosed in cardiology settings from Egypt, the United Arab Emirates and Turkey, were recruited in cohorts 3-5. Data from patient populations in the Middle East related to the rates of stroke/systemic embolism, major bleeding and all-cause mortality 1 year after diagnosis of AF and treatment strategies, based on the stroke and bleeding risk, have been analysed and compared with the rest of the world. The use of antithrombotic treatment in the Middle East was generally higher than the non-Middle East, with increased prescription of antiplatelet therapy (AP) therapy. Appropriate use of Factor Xa inhibitors/direct thrombin inhibitors (DTIs) were 74.4% and Factor Xa/DTI + APs were 70.4% in the overall population, whereas they were 57.1% and 63.6%, respectively, in the Middle East.

CONCLUSION

We have found that rates of stroke and bleeding were lower, although mortality was higher, in the Middle East population. This paper describes the baseline characteristics, patterns of antithrombotic treatment and 1-year outcomes in Middle East AF patients.

TRIAL REGISTRATION

http://www.clinicaltrials.gov . Identifier, NCT01090362.

A case of renal artery embolism treated by selective intra-arterial infusion of tissue plasminogen activator

Thromboembolic obstruction of the renal artery is a serious clinical problem, but rarely diagnosed. The diagnosis is not usually established until irreversible renal parenchymal damage occurs. Here, we present a case of renal artery thromboembolism in a patient who had atrial fibrillation and was treated by selective intra-arterial infusion of tissue plasminogen activator (TPA). A 69-year-old male was admitted to our hospital with a one-hour history of palpitation and epigastric pain. He had inferior myocardial infarction and percutaneous coronary intervention to the right coronary artery two weeks before. Coronary angiogram was performed, and no significant stenosis was detected. One hour later, epigastric pain spread to the left flank region. Spiral computerized tomography showed occlusion of the left renal artery. Emergency abdominal angiography was performed, and selective intra-arterial infusion of TPA was started promptly. The abdominal pain disappeared, and urine output remained adequate. Forty-eight hours later, angiographic follow-up confirmed the complete lysis of the thrombus in the left renal artery. No renal or hemorrhagic complications were observed, and the patient was discharged four days later with normalized renal function on oral anticoagulation.