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Thromb Haemost 2009; 101(05): 938-942
DOI: 10.1160/TH08-10-0635
Cardiovascular Biology and Cell Signalling
Schattauer GmbH

Gender differences in stroke risk of atrial fibrillation patients on oral anticoagulant treatment

Daniela Poli
1   Department of Medical and Surgical Critical Care, University of Florence and Department of Heart and Vessels, Thrombosis Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
,
Emilia Antonucci
1   Department of Medical and Surgical Critical Care, University of Florence and Department of Heart and Vessels, Thrombosis Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
,
Elisa Grifoni
1   Department of Medical and Surgical Critical Care, University of Florence and Department of Heart and Vessels, Thrombosis Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
,
Rosanna Abbate
1   Department of Medical and Surgical Critical Care, University of Florence and Department of Heart and Vessels, Thrombosis Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
,
Gian Franco Gensini
1   Department of Medical and Surgical Critical Care, University of Florence and Department of Heart and Vessels, Thrombosis Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
2   Centro S. Maria agli Ulivi, Fondazione Don Carlo Gnocchi Onlus IRCCS, Impruneta, Florence, Italy
,
Domenico Prisco
1   Department of Medical and Surgical Critical Care, University of Florence and Department of Heart and Vessels, Thrombosis Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
› Author Affiliations
Further Information

Publication History

Received: 02 October 2008

Accepted after major revision: 12 February 2009

Publication Date:
24 November 2017 (online)

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Summary

The efficacy of adjusted-dose oral anticoagulant treatment (OAT) in the prevention of stroke in atrial fibrillation (AF) is well documented. Available data show that AF patients are widely heterogeneous in terms of ischaemic stroke risk. The role of female gender as a predictor of stroke risk is inconsistent, in particular it is unclear if warfarin treatment is able to prevent stroke equally in both sexes. We performed a prospective study on 780 AF patients on OAT, followed by an Anticoagulation Clinic, to evaluate if female gender is a risk factor for stroke among patients on OAT and if the quality of anticoagulation is different between genders. No difference was found in relation to the quality of anticoagulation between genders (p=0.5). During follow-up 33 patients had major bleedings (rate 1.37x100 pt/yrs) but no difference was found between genders in bleeding risk. Forty patients had ischaemic events [rate 1.66x100 pt/yrs; males rate 1.2 x100 pt/yrs; females rate 2.43x100 pt/yrs; p=0.042; relative risk (RR) of females vs. males 2.0 (95% confidence interval [CI] 1.3–3.1); p= 0.004]. The higher rate of ischaemic events in females with respect to males was confirmed at Cox regression analysis after correction for age (p=0.009). In addition, strokes occurring in females were more disabling, and RR for severe and fatal stroke, defined according to Modified Rankin scale, of females vs. males was 3.1 (95% CI 1.3–6.5; p=0.001). In conclusion, our data show a higher risk of stroke in anticoagulated AF females with respect to males, despite a similar quality of anticoagulation.

Keywords

Atrial fibrillation - stroke - warfarin - female gender - quality of anticoagulation
 

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