Impact of different anticoagulation management strategies on outcomes in atrial fibrillation: Dutch and Belgian results from the GARFIELD-AF registry

Jaap Seelig*, Martin E. W. Hemels, Olivier Xhaet, Maarten C. M. Bongaerts, Axel de Wolf, Bjorn E. Groenemeijer, Alex Heyse, Pieter Hoogslag, Joeri Voet, Jean-Paul R. Herrman, Geert Vervoort, Walter Hermans, Bart Wollaert, Lucas V. A. Boersma, Kurt Hermans, Andreas Lucassen, Stefan Verstraete, Henk J. Adriaansen, Georges H. Mairesse, Willem F. TerpstraDirk Faes, Mathijs Pieterse, Saverio Virdone, Freek W. A. Verheugt, Frank Cools, Hugo ten Cate, GARFIELD-AF Investigators

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background The uptake rate of non-vitamin K oral anticoagulants (NOAC) for the treatment of non-valvular atrial fibrillation (AF) was far lower in the Netherlands (NL) compared to Belgium (BE). Also, patients on VKA in NL were treated with a higher target international normalized ratio (INR) range of 2.5 to 3.5. Objectives To explore the effect of these differences on thromboembolism (TE) and bleeding. Methods Data from the GARFIELD-AF registry was used. Patients with new-onset AF and >= 1 investigator-determined risk factor for stroke were included between 2010 and 2016. Event rates from 2 years of follow-up were used. Results In NL and BE, 1186 and 1705 patients were included, respectively. Female sex (42.3% vs 42.2%), mean age (70.7 vs 71.3 years), CHA(2)DS(2)-VASc (3.1 vs 3.1), and HAS-BLED score (1.4 vs 1.5) were comparable between NL and BE. At diagnosis in NL vs BE, 72.1% vs 14.6% received vitamin K antagonists (VKA) and 17.8% vs 65.5% NOACs, varying greatly across cohorts. Mean INR was 2.9 (+/- 1.0) and 2.4 (+/- 1.0) in NL and BE, respectively. Event rates per 100 patient-years in NL and BE, respectively, of all-cause mortality (3.38 vs 3.90; hazard ratio [HR] 0.86, 95% confidence interval [CI] 0.65-1.15), ischemic stroke/TE (0.82 vs 0.72; HR 1.14, 95% CI 0.62-2.11), and major bleeding (2.06 vs 1.54; HR 1.33, 95% CI 0.89-1.99) did not differ significantly. Conclusions In GARFIELD-AF, despite similar characteristics, patients on anticoagulants were treated differently in NL and BE. Although the rate of major bleeding was 33% higher in NL, variations in bleeding, mortality, and TE rates were not statistically significant.

Original languageEnglish
Pages (from-to)3280-3288
Number of pages9
JournalJournal of Thrombosis and Haemostasis
Issue number12
Early online date25 Sept 2020
Publication statusPublished - Dec 2020


  • anticoagulants
  • hemorrhage
  • international normalized ratio
  • registries
  • stroke
  • RISK


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