Department of Medicine and Cardiology, The Wright Center for Graduate Medical Center, Scranton, Pennsylvania.
Department of Medicine and Cardiology, The Wright Center for Graduate Medical Center, Scranton, Pennsylvania.
Am J Cardiol. 2014 Feb 1;113(3):485-90. doi: 10.1016/j.amjcard.2013.10.035. Epub 2013 Nov 11.
Studies comparing gender-specific outcomes in patients with atrial fibrillation (AF) have reported conflicting results. Gender differences in cerebrovascular accident/systemic embolism (CVA/SE) or major bleeding outcomes with novel oral anticoagulant (NOAC) use are not known. The goal of this analysis was to perform a systematic review and meta-analysis evaluating gender differences in residual risk of CVA/SE and major bleeding outcomes in patients with nonvalvular AF treated with either warfarin or NOAC. Sixty-four randomized studies were identified using keywords "gender," "AF," and "CVA." Using the Preferred Reporting Items for Systemic Reviews and Meta-analysis method, 6 studies met criteria for inclusion in this meta-analysis. CVA/SE and major bleeding outcomes were separately analyzed in cohorts receiving warfarin and NOAC agents, comparing men with women. Women with AF taking warfarin were at a significantly greater residual risk of CVA/SE compared with men (odds ratio 1.279, 95% confidence interval 1.111 to 1.473, Z = -3.428, p = 0.001). No gender difference in residual risk of CVA/SE was noted in patients with AF receiving NOAC agents (odds ratio 1.146, 95% confidence interval 0.97 to 1.354, p = 0.109). Major bleeding was less frequent in women with AF treated with NOAC. In conclusion, women with AF treated with warfarin have a greater residual risk of CVA/SE and an equivalent major bleeding risk, whereas those treated with NOAC agents deemed superior to warfarin are at equivalent residual risk of CVA/SE and less major bleeding risk compared with men. These results suggest an increased net clinical benefit of NOAC agents compared with warfarin in treating women with AF.
比较心房颤动（AF）患者性别特异性结局的研究报告结果相互矛盾。新型口服抗凝剂（NOAC）使用时，性别差异对脑血管意外/系统性栓塞（CVA/SE）或主要出血结局的影响尚不清楚。本分析的目的是进行系统评价和荟萃分析，评估非瓣膜性 AF 患者使用华法林或 NOAC 治疗时，CVA/SE 和主要出血结局的残余风险的性别差异。使用关键字“性别”、“AF”和“CVA”，共确定了 64 项随机研究。根据系统评价和荟萃分析的首选报告项目方法，有 6 项研究符合纳入本荟萃分析的标准。分别分析了接受华法林和 NOAC 药物治疗的队列中的 CVA/SE 和主要出血结局，比较了男性和女性。服用华法林的 AF 女性发生 CVA/SE 的残余风险显著高于男性（比值比 1.279，95%置信区间 1.111 至 1.473，Z = -3.428，p = 0.001）。接受 NOAC 药物治疗的 AF 患者中，CVA/SE 的残余风险无性别差异（比值比 1.146，95%置信区间 0.97 至 1.354，p = 0.109）。NOAC 治疗的 AF 女性大出血较少。结论：服用华法林的 AF 女性发生 CVA/SE 的残余风险更高，大出血风险相当，而服用 NOAC 药物的女性与男性相比，CVA/SE 的残余风险相当，大出血风险较低。这些结果表明，与华法林相比，NOAC 药物在治疗 AF 女性方面具有更大的净临床获益。
