Giner-Soriano Maria, Prat-Vallverdú Oriol, Ouchi Dan, Vilaplana-Carnerero Carles, Morros Rosa
Fundació Institut Universitari Per a la Recerca a l'Atenció Primària De Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
Universitat Autònoma De Barcelona (Cerdanyola del Vallès), Bellaterra, Spain.
Front Pharmacol. 2023 Feb 7;14:1110036. doi: 10.3389/fphar.2023.1110036. eCollection 2023.
To describe the sex and gender differences in the treatment initiation and in the socio-demographic and clinical characteristics of all patients initiating an oral anticoagulant (OAC), and the sex and gender differences in prescribed doses and adherence and persistence to the treatment of those receiving direct oral anticoagulants (DOAC). Cohort study including patients with non-valvular atrial fibrillation (NVAF) who initiated OAC in 2011-2020. Data proceed from SIDIAP, Information System for Research in Primary Care, in Catalonia, Spain. 123,250 people initiated OAC, 46.9% women and 53.1% men. Women were older and the clinical characteristics differed between genders. Women had higher risk of stroke than men at baseline, were more frequently underdosed with DOAC and discontinued the DOAC less frequently than men. We described the dose adequacy of patients receiving DOAC, finding a high frequency of underdosing, and significantly higher in women in comparison with men. Adherence was generally high, only with higher levels in women for rivaroxaban. Persistence during the first year of treatment was also high in general, being significantly more persistent women than men in the case of dabigatran and edoxaban. Dose inadequacy, lack of adherence and of persistence can result in less effective and safe treatments. It is necessary to conduct studies analysing sex and gender differences in health and disease.
描述开始口服抗凝剂（OAC）治疗的所有患者在治疗起始、社会人口学和临床特征方面的性别差异，以及接受直接口服抗凝剂（DOAC）治疗的患者在规定剂量、依从性和持续性方面的性别差异。队列研究纳入了2011年至2020年开始使用OAC的非瓣膜性心房颤动（NVAF）患者。数据来自西班牙加泰罗尼亚初级保健研究信息系统SIDIAP。123250人开始使用OAC，其中女性占46.9%，男性占53.1%。女性年龄较大，性别之间的临床特征存在差异。女性在基线时中风风险高于男性，使用DOAC时剂量不足的情况更频繁，且停用DOAC的频率低于男性。我们描述了接受DOAC治疗患者的剂量充足情况，发现剂量不足的频率很高，且女性明显高于男性。总体依从性较高，仅利伐沙班在女性中的依从性水平更高。治疗第一年的持续性总体也较高，在达比加群和依度沙班的情况下，女性的持续性明显高于男性。剂量不足、缺乏依从性和持续性可能导致治疗效果和安全性降低。有必要开展分析健康和疾病中性别差异的研究。
