Loikas Desirée, Forslund Tomas, Wettermark Björn, Schenck-Gustafsson Karin, Hjemdahl Paul, von Euler Mia
Karolinska Institutet, Department of Medicine Solna, Clinical Epidemiology Unit/Clin. Pharmacol, Stockholm, Sweden; Stockholm County Council, Department of Healthcare Development, Stockholm, Sweden.
Karolinska Institutet, Department of Medicine Solna, Cardiology Unit, Centre for Gender Medicine, Stockholm, Sweden.
Am J Cardiol. 2017 Oct 15;120(8):1302-1308. doi: 10.1016/j.amjcard.2017.07.002. Epub 2017 Jul 21.
To examine sex differences in thromboprophylaxis in patients with atrial fibrillation before and after the introduction of non-vitamin K oral anticoagulants, we performed a cross-sectional registry study based on anonymized individual-level patient data of all individuals with a diagnosis of nonvalvular atrial fibrillation (International Classification of Diseases, Tenth Revision code I48) in the region of Stockholm, Sweden (2.2 million inhabitants), in 2011 and 2015, respectively. Thromboprophylaxis improved considerably during the period. During 2007 to 2011, 23,198 men and 18,504 women had an atrial fibrillation diagnosis. In 2011, more men than women (53% men vs 48% women) received oral anticoagulants (almost exclusively warfarin) and more women received aspirin only (35% women vs 30% men), whereas there was no sex difference for no thromboprophylaxis (17%). During 2011 to 2015, 27,237 men and 20,461 women had a diagnosis of atrial fibrillation. Compared with the earlier time period, a higher proportion used oral anticoagulants (71% women vs 70% men), but fewer women ≥80 years received anticoagulants (67% women vs 72% men), more women received aspirin (15% women vs 13% men), and fewer women had no thromboprophylaxis (15% women vs 17% men). Patients with co-morbidities potentially complicating oral anticoagulant use used more oral anticoagulant in 2015 compared with 2011. The sex differences observed in 2011 with fewer women using oral anticoagulants had disappeared in 2015 except in women 80 years and older and in patients with complicated co-morbidity.
为研究在非维生素K口服抗凝剂应用前后，心房颤动患者血栓预防方面的性别差异，我们基于瑞典斯德哥尔摩地区（220万居民）2011年和2015年所有诊断为非瓣膜性心房颤动（国际疾病分类第十版代码I48）个体的匿名个体水平患者数据，开展了一项横断面登记研究。在此期间，血栓预防情况有了显著改善。2007年至2011年，有23198名男性和18504名女性被诊断为心房颤动。2011年，接受口服抗凝剂治疗的男性多于女性（男性为53%，女性为48%，口服抗凝剂几乎均为华法林），仅接受阿司匹林治疗的女性更多（女性为35%，男性为30%），而在未进行血栓预防方面无性别差异（均为17%）。2011年至2015年，有27237名男性和20461名女性被诊断为心房颤动。与早期相比，使用口服抗凝剂的比例更高（女性为71%，男性为70%），但80岁及以上女性接受抗凝剂治疗的比例更低（女性为67%，男性为72%），接受阿司匹林治疗的女性更多（女性为15%，男性为13%），未进行血栓预防的女性更少（女性为15%，男性为17%）。与2011年相比，2015年患有可能使口服抗凝剂使用复杂化的合并症的患者使用口服抗凝剂更多。2011年观察到的女性使用口服抗凝剂较少的性别差异在2015年消失，80岁及以上女性和患有复杂合并症的患者除外。
