Korean Circ J.  2022 Aug;52(8):593-603. 10.4070/kcj.2021.0399.

Association of Gender With Clinical Outcomes in a Contemporary Cohort of Patients With Atrial Fibrillation Receiving Oral Anticoagulants

• Kim M
• Kim J
• Kim JB
• Park J
• Park JK
• Kang KW
• Shim J
• Choi EK
• Lee YS
• Park HW
• Joung B

• KMID: 2532329
• DOI: http://doi.org/10.4070/kcj.2021.0399

Abstract

Background and Objectives
In patients with atrial fibrillation (AF), females taking vitamin K antagonist are at higher risk of stroke or systemic embolism (SSE), bleeding and all-cause death than males. This study investigated the relationship between sex and adverse clinical events in a contemporary AF patient cohort taking anticoagulation.
Methods
This prospective multicenter AF registry study comprised 6,067 patients with AF (mean age, 70±9 years; men, 59%) with intermediate to high risk of stroke (CHA ₂ DS ₂-VAscore ≥1) and receiving oral anticoagulation therapy. Adverse clinical outcomes, including SSE, bleeding, death were evaluated in patients stratified by sex and anticoagulation patterns.
Results
Women were older and used more direct oral anticoagulants (85% vs. 78%, p<0.001) than men. During a median (25 ^the and 75 ^the percentiles) follow-up of 30 (24, 38) months, the incidence rate and risk of SSE (0.7 in women vs. 0.7 in men per 100 person-years) and major bleeding (0.1 in women vs. 0.1 in men per 100 person-years) were not different between the sexes. However, women had a lower all-cause death rate (0.4 in women vs. 0.6 in men per 100 person-years, hazard ratio: 0.48, 95% confidence interval: 0.25–0.91, p=0.025) than men.
Conclusions
In contemporary anticoagulation for AF, SSE and major bleeding risks did not differ between sexes. However, women showed a lower risk of all-cause death rate than men, indicating that the use of oral anticoagulants for treating AF in females does not appear to be a risk factor for adverse clinical events.

Keyword

Atrial fibrillation; Female; Anticoagulants

Figure

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  Figure 1 Cumulative incidence of stroke or systemic embolism (A), major bleeding (B), and all-cause death (C).

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  Figure 2 Forest plot representation of clinical factors including anticoagulation associated with the primary endpoint (stroke or systemic embolism).CI = confidence interval; DOAC = direct oral anticoagulant; HR = hazard ratio; HTN = hypertension; MI = myocardial infarction; TIA = transient ischemic attack; VKA = vitamin K antagonist.

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