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Antithrombotic treatment for stroke prevention in non-

valvular atrial fibrillation patients in South East Asia and
East Asia region : a systematic review

Study Protocol Version 1.3

01-03-2018

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Review title and timescale

Antithrombotic treatment for stroke prevention in non-valvular atrial fibrillation
Title patients in South East Asia and East Asia region : a systematic review

Anticipated start date 1 July 2018

Anticipated completion
31 December 2018
date

Protocol has not yet finalized [ v ]

Started Completed
Stage of review at time
Preliminary searches
of this submission
Piloting of the study selection process
Formal screening of search results against eligibility criteria
Data extraction
Risk of bias (quality) assessment
Data analysis

Review team details

Named contact Nurul Qalby, MD
Named contact email n.qalby@amc.uva.nl
C0-329 Academic Medical Center, University of Amsterdam, Meibergdreef 9
Named contact address 1105 AZ Amsterdam

Name contact phone

+31618935147
number
Organisational Academic Medical Center, University of Amsterdam, Netherlands;
affiliation of the review Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
Review team members Prof. J.R. de Groot, MD, PhD, Department of Cardiology, Academic Medical
and their Center, University of Amsterdam, Netherlands. C.E.J.M. Limpens, PhD, Academic
organisational Medical Center, University of Amsterdam, Netherlands. D.R. Pabittei, MD, PhD,
affiliations Department of Cardio-Thoracic Surgery, Academic Medical Center, University of
Amsterdam, Netherlands.
Funding
sources/sponsors Indonesian Endowment Fund for Education

Conflicts of interest
None
Collaborators
None

Review methods

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■ How is the utilization of antithrombotic treatment as stroke prevention in
non-valvular atrial fibrillation patients in SEA and EA regions?

Review question(s) ■ What are internal and external factors that may have influence on the
utilization?

This review will search from the following electronic bibliographic databases :
Pubmed/Medline.

The search strategy will include both registered and unregistered terms. All the
Searches search terms on each database will be published in this protocol.

There will be no language restrictions. Studies published from the earliest to

recent as the search date will be included. The searches will be done again before
the final analyses and any further studies are retrieved for inclusion.
URL to search strategy To be added later
Condition or domain
Non-valvular atrial fibrillation.
being studied
Patients > 18 years old with non-valvular atrial fibrillation. Exclusion criteria :
Participants/population prior history of long-term antithrombotic drug use which is not related to atrial
fibrillation, valvular atrial fibrillation, or atrial flutter
Intervention(s), Oral antithrombotic therapy with choice of antiplatelet agent (aspirin,
exposure(s) clopidogrel), antagonist vitamin K (warfarin, coumadin, dabigatran, rivaroxaban,
apixaban) or combination of those
No antithrombotic therapy or other options of antithrombotic therapy which
Comparator(s)/control
listed in intervention
Types of study to be We will include only observational studies (cohort and cross-sectional studies) to
included initially define the answer for the research questions.

Only research in South East Asia and East Asia region will be included.
Context
- Utilization rates of types of antithrombotic drugs in stroke prevention
treatment for atrial fibrillation in SEA and EA region
Primary outcome(s) - Factors influencing utilization rates of types of antithrombotic drugs in
stroke prevention treatment for atrial fibrillation in SEA and EA region

All components/charcteristics of patients/populations treated with types of

Secondary outcomes antithrombotic drug and clinical outcome

Two independent review authors will screen the title and/or abstracts of studies
retrieved from the databases using the search strategy. They will investigate
Data extraction which studies potentially meet the inclusion criteria. Then the full text of studies
(selection and coding) considered potentially eligible will be retrieved and examined for eligibility. In
case of any discrepancies, the particular study’s eligibility will be resolved
through discussion and if necessary, will be assessed by a third reviewer.

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A modified extraction form will be used to extract data from the included studies
to synthesize evidence. Extracted informations are : first author, year of
publication, publication type, country of study, type of study, database, sample
size, participants/population, inclusion and exclusion criteria, type of
intervention, study intention, methods, results, outcomes, year of inclusion’s
begin, year of inclusion’s end, age, BMI, weight, gender (male), type of AF,
CHADS2 score, CHA2DS2VASc score, HASBLED score, duration of intervention,
percentage of antithrombotic use, INR, percentage of comorbidities, all cause
death, cardiovascular death, bleeding event, thromboembolic event, and other
relevant information. If there is any missing data, study author will be contacted
to obtain those data.
Two independent review authors will assess the risk of bias from the included
Risk of bias (quality)
studies using National Health Institute quality assessment tool for observational
assessment
cohort.
The review authors will produce a narrative synthesis of the findings from the
included studies and provide summaries of the results. Furthermore the
Strategy for data
synthesized data will be analyzed using simple and multiple regression on SPSS to
synthesis
determine which factors influence the utilization of antithrombotic drugs in these
regions.
If necessary data available, subgroup analyses of different types of participants
(e.g. by age, disease status, ethnicity); different types of intervention (e.g. drug
dose, presence or absence of particular components of intervention); different
Analysis of subgroups
settings (e.g. acute or primary care sector, professional or family care) will be
or subsets
done by qualitative synthesis. However, specification of the groups is not
possible to be decided in advance.

General information
Type of review and
This review is a systematic review about intervention in cardiovascular area.
method of review
Language English
Country Netherlands
Other registration
None
details
Reference and/or URL
for published protocol Not applicable

Dissemination plans
The review will be submitted to a leading journal in this field.
Systematic review; atrial fibrillation; antithrombotic treatment; South East Asia ;
Keyword
East Asia; stroke
Details of any existing
review of the same
topic by the same None
authors

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Current review status Ongoing
Additional information
None
Details of final
report/publication(s) To be filled after the review is published