Samuel Z. Goldhaber, MD


October 15, 2013

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Hello. This is Dr. Sam Goldhaber from the Clot Blog, speaking to you from the European Society of Cardiology (ESC) Congress in Amsterdam.

Today I am going to talk about a symposium at ESC[1] that was based on the GARFIELD atrial fibrillation (AF) cohort study. GARFIELD AF is a very ambitious registry -- a perspective cohort study of about 55,000 patients with AF being studied in 5 different cohorts, each of 10,000-plus patients. Cohorts 1 and 2 have been fully enrolled and we are about halfway through enrollment in cohort 3, so about 25,000 patients have been enrolled so far in the GARFIELD AF observational study.

The Results, So Far

What we learned at the GARFIELD AF symposium at ESC is that patients continue to not be anticoagulated if they are at high risk for AF. Through cohort 1, the rate was about 40% of high-risk patients with high CHA2DS2-VASc scores not receiving anticoagulation. We thought that perhaps as more education is instilled in our colleagues and in the public, there would be more of an uptake of anticoagulation of these patients at high risk for stroke.

Cohort 2, however, shows that the failure to anticoagulate patients with high CHA2DS2-VASc scores who are at risk for stroke continues to be about 40%, so we will be able to follow what happens with the rate of patients being anticoagulated in cohorts 3, 4, and 5 of GARFIELD AF, but the update from ESC is that our work is cut out for us.

Much to Learn

We need to understand better why patients are not being anticoagulated. It appears so far that about half the time the physician decides not to do it for some intentional reasons, perhaps fearing the risk of anticoagulation, the bleeding risk, or other reasons that are sometimes difficult to discern. I personally believe that the availability of novel oral anticoagulants, which across the board have a much lower rate of intracranial hemorrhage than warfarin, should make us more at ease and facilitate our anticoagulating these high-risk patients, but I thought it was important to bring you this update. This 40% figure of failure to anticoagulate patients is about the same as the Euro Heart Survey[2] from 12 years ago, but I am hoping that at the next ESC meeting, perhaps we will have data from cohort 3 of GARFIELD AF, and perhaps I will have more encouraging news to share with you and be able to tell you at that time that a higher proportion of patients at risk for stroke from AF are being anticoagulated.

This is Dr. Sam Goldhaber, signing off for the Clot Blog.


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