Abstract 16815: Female Sex and Its Relation With Poor Control of Oral Anticoagulation With Coumarin Derivatives: A Systematic Review and Meta-Analysis

Abstract

Introduction: Sex-differences in the quality of oral anticoagulation control have been reported,although with controversial evidence. Our hypothesis was that sex would be associated withoral anticoagulation control. We performed a systematic review and meta-analysis to investigatethis association. Methods: We searched for studies on MEDLINE, BVS, CINAHL, EMBASE,Cochrane and Web of Science. We included observational and experimental studies withparticipants aged >18 years of both sexes, on oral anticoagulation with warfarin or othercoumarin derivatives indicated for long-term use. The outcome of interest was time intherapeutic range (TTR), calculated by the Rosendaal method. We synthesized data from theselected studies and developed the meta-analysis. Odds ratios (OR) for binary variables andmean differences (MD) for continuous variables were pooled using the random-effects modelswith estimation via the DerSimonian-Laird method. Results: Thirteen studies with 89,745patients (45.08% women) were included. Nine studies were assessed in the meta-analysis frombinary variables (OR=0.89; 95% CI=0.80, 1.00; z=-1.96; p=0.05; I 2 =74%) (Fig. 1) and fourstudies with continuous variables (MD=-3.02; 95% CI=-4.43, -1.62; z=-4.22; p<0.0001; I 2 =0%)(Fig. 2). The pooled estimates indicated that women were associated with lower TTR than men. Fig. 1 Analysis of sex effect on oral anticoagulation control. Fig. 2 Analysis of sex effect on oral anticoagulation control. In conclusion, this systematic review showed that the female sex was associated with lowerTTR than male sex. Our results suggest the need for innovative strategies to improve healthcarefocused on women.