The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Reconsiderando gramsci: hegemonia no direito global Gramsci reconsidered: hegemony in global law

"Entre direitos iguais, a força decide", proferiu karl marx ao descrever a antinomia do direito em situações antagônicas das relações de produção capitalistas, em que "o direito [oferece resistência] ao direito" nesse ponto, marx aborda uma questão que se situa no centro de todas as teorias jurídicas críticas: que tipo de violência é velada por meio do mecanismo de ocultação denominado "direito"? Para responder a esta questão, tentar-se-á, a seguir, tornar a teoria da hegemonia de antonio gramsci e seu modelo de direito hegemônico produtivos para o campo da teoria do direito. Tal tarefa tem de lidar com a dupla dificuldade de que, por um lado, gramsci não foi um teórico do direito no sentido mais estrito, razão pela qual o potencial de sua teoria para uma análise do direito raramente foi utilizada. Por outro lado, sua abordagem só pode ser empregada por meio de uma crítica às restrições relacionadas a seu tempo. isso se aplica especialmente à sua concepção de economia como a base e a núcleo essencialista oculto (laclau; mouffe, 2001:69), assim como à sua ideia de 'classismo' sob a forma de um enfoque unilateral das classes, em que há preferencialmente mais de um "pluralismo de poder" e inúmeras lutas (litowitz, 2000: 536). Recuperar-se-á, consequentemente, argumentos-chave, ampliando-os pela utilização das recentes descobertas feitas pelas abordagens feminista e neomaterialista da teoria jurídica, bem como as análises de foucault acerca das tecnologias de poder. por fim, uma interpretação da teoria sistêmica das autonomizações comunicativas.<br>"Between equal rights, force decides," said karl marx, describing the antinomy of law in antagonistic situations of capitalist production relations, in which "law [stands] against law". he here addresses a question that lies at the centre of all critical legal theories: what violence is blurred in the medium of the concealment mechanism called 'law'? To answer this question, we shall attempt below to make antonio gramsci's hegemony theory and his model of a hegemonic law fertile for the theory of law. This task has to cope with the twofold difficulty that on the one hand gramsci was no theoretician of law in the narrower sense, which is why the potential of his theory for an analysis of law has only seldom been made use of. On the other, his approach can only be taken up through a critique of restrictions associated with his times. This applies particularly to his conception of the economy as the basis and as the concealed essentialist core (laclau/mouffe 2001: 69), as well as to his 'classism' in the form of a one-sided focusing on classes, where there is instead more of a "pluralism of power" and a multiplicity of struggles (litowitz 2000: 536). We shall accordingly regain key arguments by extending them using current findings of feminist and neo-materialist approaches to legal theory, as well as foucault's analyses of power technologies and finally a systems-theory interpretation of communicative autonomizations

Correction to: Comparative effectiveness and safety of non-vitamin K antagonists for atrial fibrillation in clinical practice: GLORIA-AF Registry

International audienceIn this article, the name of the GLORIA-AF investigator Anastasios Kollias was given incorrectly as Athanasios Kollias in the Acknowledgements. The original article has been corrected

Patterns of oral anticoagulant use and outcomes in Asian patients with atrial fibrillation: a post-hoc analysis from the GLORIA-AF Registry

Background: Previous studies suggested potential ethnic differences in the management and outcomes of atrial fibrillation (AF). We aim to analyse oral anticoagulant (OAC) prescription, discontinuation, and risk of adverse outcomes in Asian patients with AF, using data from a global prospective cohort study. Methods: From the GLORIA-AF Registry Phase II-III (November 2011-December 2014 for Phase II, and January 2014-December 2016 for Phase III), we analysed patients according to their self-reported ethnicity (Asian vs. non-Asian), as well as according to Asian subgroups (Chinese, Japanese, Korean and other Asian). Logistic regression was used to analyse OAC prescription, while the risk of OAC discontinuation and adverse outcomes were analysed through Cox-regression model. Our primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACE). The original studies were registered with ClinicalTrials.gov, NCT01468701, NCT01671007, and NCT01937377. Findings: 34,421 patients were included (70.0&nbsp;±&nbsp;10.5 years, 45.1% females, 6900 (20.0%) Asian: 3829 (55.5%) Chinese, 814 (11.8%) Japanese, 1964 (28.5%) Korean and 293 (4.2%) other Asian). Most of the Asian patients were recruited in Asia (n&nbsp;=&nbsp;6701, 97.1%), while non-Asian patients were mainly recruited in Europe (n&nbsp;=&nbsp;15,449, 56.1%) and North America (n&nbsp;=&nbsp;8378, 30.4%). Compared to non-Asian individuals, prescription of OAC and non-vitamin K antagonist oral anticoagulant (NOAC) was lower in Asian patients (Odds Ratio [OR] and 95% Confidence Intervals (CI): 0.23 [0.22-0.25] and 0.66 [0.61-0.71], respectively), but higher in the Japanese subgroup. Asian ethnicity was also associated with higher risk of OAC discontinuation (Hazard Ratio [HR] and [95% CI]: 1.79 [1.67-1.92]), and lower risk of the primary composite outcome (HR [95% CI]: 0.86 [0.76-0.96]). Among the exploratory secondary outcomes, Asian ethnicity was associated with higher risks of thromboembolism and intracranial haemorrhage, and lower risk of major bleeding. Interpretation: Our results showed that Asian patients with AF showed suboptimal thromboembolic risk management and a specific risk profile of adverse outcomes; these differences may also reflect differences in country-specific factors. Ensuring integrated and appropriate treatment of these patients is crucial to improve their prognosis. Funding: The GLORIA-AF Registry was funded by Boehringer Ingelheim GmbH