Department of Cardiology, Heart Center Co., Tampere University Hospital, Ensitie 4, Tampere, Finland.
Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Haartmaninkatu 4, Helsinki, Finland.
Eur Heart J Cardiovasc Pharmacother. 2019 Jan 1;5(1):29-36. doi: 10.1093/ehjcvp/pvy026.
Females with atrial fibrillation (AF) have been suggested to carry a higher risk for thromboembolic events than males. We compared the residual risk of stroke, bleeding events, and cardiovascular and all-cause mortality among female and male AF patients taking warfarin.
Data from several nationwide registries and laboratory databases were linked with the civil registration number of the patients. A total of 54 568 patients with data on the quality of warfarin treatment (time in therapeutic range) 60 days prior to the events were included (TTR60). Gender differences in the endpoints were reported for the whole population, pre-specified age groups, and different TTR60 groups. During the 3.2 ± 1.6 years follow-up, there were no differences in the adjusted risk of stroke [hazard ratio (HR) 0.97, 95% confidence interval (CI) 0.91-1.03, P = 0.304] between the genders. Cardiovascular mortality (HR 0.82, 95% CI 0.78-0.88, P < 0.001) and all-cause mortality (HR 0.79, 95% CI 0.75-0.83, P < 0.001) were lower in women when compared with men. There were no differences in the risk of stroke, cardiovascular mortality, and all-cause mortality between the genders in the TTR60 categories except for those with TTR60 <50%. Bleeding events were less frequent in females (HR 0.52, 95% CI 0.49-0.56, P < 0.001).
There were no differences in the risk of stroke between female and male AF patients taking warfarin. Cardiovascular mortality, all-cause mortality, and risk of bleeding events were lower in females. Hence, female gender was not a risk marker for adverse outcomes in AF patients with proper warfarin therapy.
有研究表明，与男性相比，女性心房颤动（AF）患者发生血栓栓塞事件的风险更高。我们比较了接受华法林治疗的女性和男性 AF 患者的中风、出血事件、心血管和全因死亡率的残余风险。
将来自多个全国性登记处和实验室数据库的数据与患者的公民登记号码相链接。共纳入 54568 例在事件发生前 60 天有华法林治疗质量（治疗范围内时间）数据的患者（TTR60）。报告了全人群、预先指定年龄组和不同 TTR60 组的终点性别差异。在 3.2±1.6 年的随访期间，男女之间中风的调整风险无差异[风险比（HR）0.97，95%置信区间（CI）0.91-1.03，P=0.304]。与男性相比，女性的心血管死亡率（HR 0.82，95%CI 0.78-0.88，P<0.001）和全因死亡率（HR 0.79，95%CI 0.75-0.83，P<0.001）较低。除 TTR60<50%外，在 TTR60 类别中，男女之间中风、心血管死亡率和全因死亡率的风险无差异。女性出血事件较少（HR 0.52，95%CI 0.49-0.56，P<0.001）。
接受华法林治疗的女性和男性 AF 患者的中风风险无差异。女性的心血管死亡率、全因死亡率和出血风险较低。因此，在适当的华法林治疗下，女性性别不是 AF 患者不良结局的风险标志物。
