Gender Differences in the Risk of Ischemic Stroke and Peripheral Embolism in Atrial Fibrillation

Abstract

Background-Previous studies provide conflicting results about whether women are at higher risk than men for thromboembolism in the setting of atrial fibrillation (AF). We examined data from a large contemporary cohort of AF patients to address this question. Methods and Results-We prospectively studied 13 559 adults with AF and recorded data on patients' clinical characteristics and the occurrence of incident hospitalizations for ischemic stroke, peripheral embolism, and major hemorrhagic events through searching validated computerized databases and medical record review. We compared event rates by patient sex using multivariable log-linear regression, adjusting for clinical risk factors for stroke, and stratifying by warfarin use. We identified 394 ischemic stroke and peripheral embolic events during 15 494 person-years of follow-up off warfarin. After multivariable analysis, women had higher annual rates of thromboembolism off warfarin than did men (3.5% versus 1.8%; adjusted rate ratio [RR], 1.6; 95% CI, 1.3 to 1.9). There was no significant difference by sex in 30-day mortality after thromboembolism (23% for both). Warfarin use was associated with significantly lower adjusted thromboembolism rates for both women and men (RR, 0.4; 95% CI, 0.3 to 0.5; and RR, 0.6; 95% CI, 0.5 to 0.8, respectively), with similar annual rates of major hemorrhage (1.0% and 1.1%, respectively). Conclusions-Women are at higher risk than men for AF-related thromboembolism off warfarin. Warfarin therapy appears be as effective in women, if not more so, than in men, with similar rates of major hemorrhage. Female sex is an independent risk factor for thromboembolism and should influence the decision to use anticoagulant therapy in persons with AF.

Lifetime risk of stroke and impact of hypertension: estimates from the adult health study in Hiroshima and Nagasaki

“…There may be, however, other potential reasons that women are at greater risk than men for atrial fibrillation-related thromboembolic events. 21,22 Elderly women (above age 85 years) were observed to have higher stroke incidence than that in men. [23][24][25] Our LTR estimates emphasized that the LTR remains a major threat and public health burden for Japan's aging society, especially for women.…”

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

“…U kobiet z AF, u których występują dodatkowe czynniki ryzyka udaru mózgu (zwłaszcza starszy wiek), ryzyko udaru również jest większe niż u mężczyzn [48,49], nawet wśród osób leczonych przeciwzakrzepowo warfaryną [50] (szczegóły -patrz rozdz. 9).…”

Arrhythmias in Women

“…14 The ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) study prospectively followed 13559 adults with AF for 2.4 years and found annual rates of thromboembolism in patients not taking warfarin of 3.5% for women compared to 1.8% for men. 15 The Canadian Registry of Atrial Fibrillation (CARAF) found that women age 75 years or more were 54% less likely to receive warfarin but twice as likely to receive acetylsalicylic acid as compared to men age 75 years or more. Physicians may be more reluctant to use warfarin anticoagulation due to reports of increased bleeding in women as compared to men, as reported in the CARAF study and SPORTIF (Stroke Prevention Using an Oral Thrombin Inhibitor in Atrial Fibrillation) trials.…”