Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil.
Centro de Ciências da Saúde, Universidade Federal do Recôncavo da Bahia, Av. do Cajueiro 1015, Cajueiro, Santo Antonio de Jesus, Bahia, 44574-490, Brazil.
Br J Clin Pharmacol. 2021 Dec;87(12):4488-4503. doi: 10.1111/bcp.14892. Epub 2021 May 26.
We sought to investigate the association between sex and oral anticoagulation control employing coumarin derivatives.
Electronic sources were MEDLINE, Biblioteca Virtual em Saúde (BVS), The Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Cochrane Central and Web of Science. Inclusion criteria were: observational and experimental studies; age ≥18 years; both sexes; treatment with any coumarin derivative for ≥3 months; any indication of long-term use; quality of oral anticoagulation measured by time in therapeutic range (TTR). The meta-analysis was developed with odds ratios (OR) for binary variables and mean differences (MD) for continuous variables, using random-effects models (DerSimonian and Laird) with 95% confidence intervals (CI).
Overall, 22 articles were selected, comprising 16 cohort studies, four cross-sectional studies and two clinical trials. The number of participants ranged from 110 to 104 505 (183 612; women: 45%). The main indication of oral anticoagulation was atrial fibrillation. Most studies reported the use of warfarin. In the meta-analysis, 15 studies were analysed using TTR as a binary variable (OR = 0.87; 95% CI = 0.78, 0.96; z = -2.75; P = .006.; I = 67%) and seven studies as a continuous variable (MD = -2.97; 95% CI = -4.80, -1.14; z = -3.19; P = .0014; I = 75%). The pooled estimates indicated that women were associated with lower TTR than men.
Our findings revealed an association between female sex and worse oral anticoagulation control. Further studies are needed with primary design to investigate sex-related factors influencing oral anticoagulation control with coumarin derivatives. Innovative strategies focused on women's health may be useful to improve patient-centred care.
我们旨在研究使用香豆素衍生物时性别与口服抗凝控制之间的关联。
电子资源包括 MEDLINE、巴西虚拟健康图书馆（BVS）、护理学及相关健康文献累积索引（CINAHL）、EMBASE、考科兰中心数据库（Cochrane Central）和 Web of Science。纳入标准为：观察性和实验性研究；年龄≥18 岁；男女不限；接受任何香豆素衍生物治疗≥3 个月；长期使用任何指示；通过治疗范围内时间（TTR）测量口服抗凝质量。使用二项变量的优势比（OR）和连续变量的平均差异（MD），使用随机效应模型（DerSimonian 和 Laird）和 95%置信区间（CI）进行荟萃分析。
共选择了 22 篇文章，包括 16 项队列研究、4 项横断面研究和 2 项临床试验。参与者人数从 110 人到 104505 人（183612 人；女性：45%）不等。口服抗凝的主要适应证为心房颤动。大多数研究报告使用华法林。荟萃分析中，有 15 项研究将 TTR 作为二项变量进行分析（OR=0.87；95%CI=0.78，0.96；z=-2.75；P=0.006；I²=67%），7 项研究作为连续变量进行分析（MD=-2.97；95%CI=-4.80，-1.14；z=-3.19；P=0.0014；I²=75%）。汇总估计表明，女性的 TTR 低于男性。
我们的研究结果表明，女性与较差的口服抗凝控制有关。需要进一步采用主要设计的研究来调查影响香豆素衍生物口服抗凝控制的与性别相关的因素。专注于女性健康的创新策略可能有助于改善以患者为中心的护理。
