J Thromb Haemost. 2014 May;12(5):595-605. doi: 10.1111/jth.12529.
The risk of bleeding on anticoagulation varies between patients. It is uncertain whether sex influences this risk.
To determine if the risk of major bleeding differs between men and women receiving anticoagulation for atrial fibrillation or venous thromboembolism(VTE).
We searched MEDLINE, EMBASE, and Cochrane databases, and relevant conference proceedings, until February 2013. We included randomized controlled trials and prospective cohort studies of patients on therapeutic anticoagulation for atrial fibrillation or VTE. Two reviewers independently extracted data. The relative risk of bleeding in men compared to women was pooled using a random-effects model.
Forty-two studies including 94 293 patients were eligible; 78 044 patients (83%) had atrial fibrillation; 16 156 patients (17%) had VTE; 37 250 patients were women (40%); and there were 4147 major bleeds. The relative risk of major bleeding for men vs. women was 1.02(95% CI 0.95–1.10; P = 0.27 for heterogeniety). The relative risk was 1.02 (95% CI 0.95–1.09) in patients with atrial fibrillation and 0.80 (95% CI 0.65–0.98) in patients with VTE (P = 0.03 for subgroup effect). Type of anticoagulant,intensity of anticoagulation, and whether patients began or were already established on anticoagulants at enrollment did not influence the relative risk of major bleeding in men compared to women.
The risk of major bleeding on anticoagulation appears to be the same in men and women, particularly if patients have atrial fibrillation. This finding is less certain for patients with VTE, in whom the risk of bleeding may be marginally lower in men compared to in women.
抗凝治疗出血风险存在个体差异。目前尚不清楚性别是否会影响这一风险。
确定男性和女性在接受房颤或静脉血栓栓塞症（VTE）抗凝治疗时大出血风险是否存在差异。
我们检索了 MEDLINE、EMBASE 和 Cochrane 数据库以及相关会议记录，检索时间截至 2013 年 2 月。我们纳入了接受治疗剂量抗凝治疗的房颤或 VTE 患者的随机对照试验和前瞻性队列研究。两位评价员独立提取数据。采用随机效应模型计算男性和女性出血风险的相对风险比（RR）。
共纳入 42 项研究，涉及 94293 例患者；78044 例（83%）患者患有房颤，16156 例（17%）患有 VTE，37250 例（40%）为女性，共有 4147 例大出血。男性大出血的 RR 为 1.02（95%CI 0.95～1.10；P=0.27，异质性检验）。房颤患者的 RR 为 1.02（95%CI 0.95～1.09），VTE 患者的 RR 为 0.80（95%CI 0.65～0.98）（P=0.03，亚组效应检验）。抗凝药物种类、抗凝强度、以及患者是否在入组时开始或已经开始抗凝治疗，均不影响男性和女性大出血的 RR 比值。
在接受抗凝治疗的患者中，出血风险似乎在男性和女性中相同，尤其是在房颤患者中。对于 VTE 患者，这一发现不太确定，因为男性的出血风险可能略低于女性。
