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Anticoagulant use similar in women, men despite stroke risk differences with AF
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The rates of anticoagulant use for stroke prevention are no different in men and women with nonvalvular atrial fibrillation, according to research published in Circulation: Cardiovascular Quality and Outcomes.
The application of thromboprophylaxis in considerable proportions of both sexes, however, is not being optimized, according to researchers.
“The results from our worldwide study suggest that women are treated no differently to men in terms of anticoagulant therapy for stroke prevention,” Gregory Y.H. Lip, MD, of the University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK, told Cardiology Today. “Thromboprophylaxis was, however, suboptimal in substantial proportions of men and women, with underuse in those at moderate-to-high risk of stroke and overuse in those at low risk.”
Gregory Y.H. Lip
Lip and colleagues from other institutions looked at data from the prospective multicenter observational Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF), comprising 858 randomly selected sites in 30 countries.
Between March 2010 and June 2013, 17,184 patients (43.8% women) who were diagnosed with nonvalvular AF in the preceding 6 weeks and had at least one additional stroke risk factor as defined by investigators were recruited.
The primary outcome sought was use of anticoagulants for stroke prevention at AF diagnosis; the category included vitamin K antagonists, Factor Xa inhibitors and direct thrombin inhibitors.
Based on the CHADS2 clinical prediction rule for estimating the risk for stroke, moderate-to-high risk for stroke was observed in more women than men (score ≥ 2; 65.1% vs. 54.7%).
Anticoagulant use did not differ overall (60.9% of men vs. 60.8% of women), nor in patients with a CHADS2 score of 2 or more (adjusted OR for women vs. men = 1; 95% CI, 0.92-1.09).
In patients at low risk, considering additional stroke risk modifiers including vascular disease, (CHA2DS2-VASc score = 0 in men, 1 in women), 41.8% of men and 41.1% of women used an anticoagulant. In patients at high risk (CHA2DS2-VASc score ≥ 2), 35.4% of men and 38.4% of women did not use an anticoagulant.
“Improvements in anticoagulation prescription and management are needed for women and men,” Lip said. “Further research is needed to understand why women with atrial fibrillation are at higher risk of stroke than men with atrial fibrillation.” – by Allegra Tiver
For more information: Lip can be reached at the Centre for Cardiovascular Sciences, City Hospital, Birmingham B18 7QH, England, UK; email: g.y.h.lip@bham.ac.uk.
Disclosure: Lip reports financial relationships with Astellas, Bayer, Biotronik, Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, Daiichi-Sankyo, Medtronic, Merck, Portola and Sanofi, Please see the full study for a list of all other authors’ relevant financial disclosures.
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