Sex and gender differences in the use of oral anticoagulants for non-valvular atrial fibrillation: A population-based cohort study in primary health care in catalonia

Abstract

Objectives: 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).Material and methods: 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.Results: 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.Conclusion: 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.

Effectiveness and safety of oral anticoagulants for non-valvular atrial fibrillation: a population-based cohort study in primary healthcare in Catalonia

“…During the period spanning 2011 to 2020, 123,250 people with NVAF were prescribed a new OAC. Their baseline socio-demographic and clinical characteristics and the persistence and adherence to treatment have been described elsewhere ( Giner-Soriano et al, 2023 ). Of these people, 90,773 (73.6%) received a dispensing for the OAC prescription and were included in the analyses of effectiveness and safety ( Figure 2 ).…”

“…In this cohort study including 90,773 people with NVAF who initiated OAC between 2011 and 2020 and with up to 10 years of follow-up, we have studied effectiveness and safety of OAC treatment, according to age categories, sex, and the presence of prevalent comorbidities and comedications. We have also investigated these outcomes for people receiving DOAC in terms of dose, adherence and treatment switch, which had not been analysed so far in our setting, although DOAC initiation already accounts for more than 50% of new treatments ( Giner-Soriano et al, 2023 ). To obtain more accurate information on drug intake, we have conducted the analyses in the cohort of patients with OAC dispensed rather than relying solely on prescription data ( Grégoire and Moisan, 2016 ).…”

“…We have recently analysed the baseline clinical characteristics and the sex and gender differences of patients initiating OAC for stroke prevention in NVAF from 2011–2020 in a Primary Health Care (PHC) cohort in Catalonia, Spain ( Giner-Soriano et al, 2023 ). In the present manuscript, we have analysed the effectiveness and safety of OAC in the above-mentioned cohort, only including patients who collected their medication in the pharmacy, and assessed by different subgroups based on sex, age, renal impairment or with other frequent comorbidities and comedications; and by dose adequacy, treatment adherence or drug switch in the case of those people treated with DOAC.…”

A pilot study to evaluate the quality of care in oral anticoagulant and antiplatelet use in patients with permanent atrial fibrillation in Irish general practice

“…The reasons for this discrepancy are not entirely clear but we do know that a history of minor bleeding is associated with NOAC underdosing ( Caso et al , 2023) and women tend to present more frequently with adverse drug reactions such as this (Giner-Soriano et al , 2023 ). It may also be due to renal function assessment; using eGFR rather than creatinine clearance can overestimate renal function in females (Howard et al , 2017 ).…”

Sex disparities for patients with atrial fibrillation in the direct oral anticoagulant era

“…First, data on OAC adherence or label-adherent prescribing were lacking, especially since females tended to have higher rates of NOAC underdosing than males. 11 Second, the study did not account for residential or other precise socioeconomic status data, although they included some data about income. In particular, the sex disparity in NOAC use was greater in rural or highly deprivation areas.…”