Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Zabrze, Poland.
Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.
Am J Med. 2018 Aug;131(8):945-955.e3. doi: 10.1016/j.amjmed.2018.03.024. Epub 2018 Apr 11.
Data on gender differences in oral anticoagulation for stroke prevention in patients with atrial fibrillation are conflicting, largely limited to regional reports and vitamin K antagonist use. We aimed to analyze gender-specific anticoagulant prescription patterns early following the introduction of non-vitamin K antagonist oral anticoagulants (NOACs) in a large, global registry on atrial fibrillation.
The Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF) is an international registry program involving patients with newly diagnosed atrial fibrillation (<3 months from arrhythmia onset). We used data from 15,092 consecutive patients (median age, 71.0 years; 45.5% were women) enrolled between 2011 and 2014. Globally, 79.7% of women and 80.2% of men were anticoagulated; the absolute between-gender difference in prevalence of anticoagulant use was -0.5% (95% confidence interval, -1.8% to 0.8%). Vitamin K antagonists were prescribed to 32.8% and 31.9% (NOACs 46.8% and 48.3%) of women and men, respectively.
No confounder for the association between gender and anticoagulant prescription was identified. Between-gender differences in anticoagulant use (lower use in women compared with men by decreasing order of magnitude of the difference) were found for CHADS-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65-74 years, sex category [female]) score = 1; CHADS (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke) score = 0; previous bleeding; age <65 years; no history of hypertension; myocardial infarction; coronary artery disease; North America region; and specialist office setting.
Globally, the prevalence of anticoagulant use is similar in women and men. The decision to prescribe oral anticoagulation seems to depend predominantly on guideline-related differences in stroke risk stratification rather than on gender.
关于房颤患者预防卒中时口服抗凝药物的性别差异的数据存在争议，且主要局限于区域性报告和维生素 K 拮抗剂的使用。我们旨在分析在一项大型国际房颤注册研究中，新型非维生素 K 拮抗剂口服抗凝药物（NOACs）应用早期抗凝药物处方的性别特异性。
全球房颤长期口服抗凝治疗注册研究（GLORIA-AF）是一项国际注册研究，纳入了新发房颤患者（发病<3 个月）。共纳入 15092 例连续患者（中位年龄 71.0 岁，45.5%为女性），入组时间为 2011 年至 2014 年。全球范围内，女性和男性抗凝治疗的比例分别为 79.7%和 80.2%；抗凝治疗使用的性别间绝对差异为-0.5%（95%置信区间，-1.8%至 0.8%）。女性和男性分别有 32.8%和 31.9%（NOACs 分别为 46.8%和 48.3%）处方维生素 K 拮抗剂。
未发现性别与抗凝药物处方之间关联的混杂因素。与抗凝药物使用相关的性别差异（女性抗凝治疗使用率低于男性，且差异的量级逐渐减小）在 CHADS-VASc（充血性心力衰竭、高血压、年龄≥75 岁、糖尿病、卒中和短暂性脑缺血发作、血管疾病、65-74 岁、性别）评分=1；CHADS（充血性心力衰竭、高血压、年龄≥75 岁、糖尿病、卒中）评分=0；既往出血史；年龄<65 岁；无高血压病史；心肌梗死；冠心病；北美地区；专科门诊）评分、既往出血史、年龄<65 岁、无高血压病史、心肌梗死、冠心病、北美地区、专科门诊中有所体现。
全球范围内，女性和男性抗凝治疗的使用率相似。抗凝药物的使用决策似乎主要取决于与指南相关的卒中风险分层差异，而不是性别。
