Background
Few data are available regarding the use of antithrombotic strategies in coronary artery disease
patients with atrial fibrillation (AF) in everyday practice. We sought to describe the
prevalence of AF and its antithrombotic management in a contemporary population of patients
with stable coronary artery disease.
Methods and Findings
CLARIFY is an international, prospective, longitudinal registry of outpatients with stable coronary
artery disease, defined as prior ( 12 months) myocardial infarction, revascularization
procedure, coronary stenosis >50%, or chest pain associated with evidence of myocardial
ischemia. Overall, 33,428 patients were screened, of whom 32,954 had data available for
analysis at baseline; of these 2,229 (6.7%) had a history of AF. Median (interquartile range)
CHA2DS2-VASc score was 4 (3, 5). Oral anticoagulation alone was used in 25.7%, antiplatelet
therapy alone in 52.8% (single 41.8%, dual 11.0%), and both in 21.5%. OAC use
was independently associated with permanent AF (p<0.001), CHA2DS2-VASc score
(p=0.006), pacemaker (p<0.001), stroke (p=0.04), absence of angina (p=0.004), decreased
left ventricular ejection fraction (p<0.001), increased waist circumference (p=0.005), and
longer history of coronary artery disease (p=0.008). History of percutaneous coronary intervention
(p=0.004) and no/partial reimbursement for cardiovascular medication (p=0.01,
p<0.001, respectively) were associated with reduced oral anticoagulant use.Conclusions
In this contemporary cohort of patients with stable coronary artery disease and AF, most of
whom are theoretical candidates for anticoagulation, oral anticoagulants were used in only
47.2%. Half of the patients received antiplatelet therapy alone and one-fifth received both
antiplatelets and oral anticoagulants. Efforts are needed to improve adherence to guidelines
in these patients.
Trial Registration
ISRCTN registry of clinical trials: ISRCTN43070564