Sex Differences in the Management of Oral Anticoagulation and Outcomes for Emergency Department Presentation of Incident Atrial Fibrillation

Islam, Sunjidatul; Dover, Douglas C.; Daniele, Patrick; Hawkins, Nathaniel M.; Humphries, Karin H.; Kaul, Padma; Sandhu, Roopinder K.

doi:10.1016/j.annemergmed.2022.03.010

Cited by 13 publications

(19 citation statements)

References 44 publications

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“… 15 In this systematic review of observational studies versus randomized clinical trials, the higher risk profiles of AF patients in clinical practice treated with apixaban 2.5 mg (vs. 5 mg) may explain (i) the higher‐than‐expected thromboembolic event rates in the clinic and (ii) the higher rates of major bleeding and mortality. 15 In addition, some recent research studies reported the sex differences in the management of OAC and outcomes 12 , 54 but further research investigating sex‐specific differences in the appropriateness of DOACs prescription in different populations of clinical practice is still needed. There is also a need of a well‐designed randomized clinical trial that compares each DOAC and specific dose with regard to sex‐specific of efficacy and safety in a representative population of clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…The stroke risk (as evaluated by the CHA 2 DS 2 ‐VASc score) is significantly higher for women with AF than for their men counterparts, regardless of the age and comorbidity profile in contrast to the CHADS 2 score 5,7–9 . Regardless or not of the CHA 2 DS 2 ‐VASc score, however, it has been reported that women are significantly less likely to receive OACs 10–12 . A recent publication demonstrated that in real life (and in contrast to the data from randomized clinical trials), women with AF are more likely to receive low‐dose direct oral anticoagulants (DOACs) than standard‐dose DOACs 13 .…”

Section: Introductionmentioning

confidence: 98%

“…5 , 7 , 8 , 9 Regardless or not of the CHA 2 DS 2 ‐VASc score, however, it has been reported that women are significantly less likely to receive OACs. 10 , 11 , 12 A recent publication demonstrated that in real life (and in contrast to the data from randomized clinical trials), women with AF are more likely to receive low‐dose direct oral anticoagulants (DOACs) than standard‐dose DOACs. 13 And, the net benefit of low‐dose DOACs compared to warfarin seems to vary from one DOAC to another.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Trends of use and factors that determine the choice of oral anticoagulants in women and men with atrial fibrillation

Lenglet

Qazi

Proulx

et al. 2022

Pharmacology Res & Perspec

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The aim was to identify sex‐specific factors linked with oral anticoagulant initiation in a cohort of patients with atrial fibrillation using administrative data from Quebec (Canada) between 2014 and 2017. Cohort entry defined as new users, that is, no claims in last 12 months, a cohort of 32 050 patients was stratified in two groups, that is, women and men. Multivariable regression models were used to identify factors of initiations for low‐ and standard‐dose direct oral anticoagulants (DOACs) versus warfarin, and low‐ versus standard‐dose DOACs. In both sexes, warfarin initiation decreased and DOAC initiation increased, with year of initiation as major factors of DOACs use. In 2017, the increase was of 2‐ to 4‐fold and 3‐ to 8‐fold for low‐ and standard‐dose DOACs (vs. warfarin), respectively. The proportion of patients starting on a low‐dose DOAC was higher in women than men. Older age for both sexes and CHADS 2 score ≥2 (only women) were major factors of low‐dose dabigatran and rivaroxaban versus warfarin use. The only significant factor of standard‐dose DOAC versus warfarin use was age of 65–79 for women or men treated with apixaban by 1.8‐ and 1.4‐fold, respectively. Factors that made women and men less likely to receive a standard‐dose DOAC versus warfarin were higher CHADS 2 (for dabigatran and rivaroxaban), HAS‐BLED and frailty scores, prior coronary disease, major bleeding, and chronic kidney disease (CKD) status. The choice of a low‐ versus standard‐dose DOAC was mainly driven by age and CKD, and higher CHADS 2 score (for dabigatran and apixaban) for both sexes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Trends of use and factors that determine the choice of oral anticoagulants in women and men with atrial fibrillation

Lenglet

Qazi

Proulx

et al. 2022

Pharmacology Res & Perspec

View full text Add to dashboard Cite

show abstract

“…26 Prior research in this area may have been susceptible to selection and information biases stemming from limited patient populations and reliance on only hospital-level data. 4,[29][30][31] Indeed, patients treated solely in primary care are typically older high-risk individuals, and the lack of primary-care data may significantly compromise the eral interpretation of previous findings. Thus, the present study's findings substantially enhance our understanding of the real-life implementation of clinical practice guidelines regarding OAC utilization in men and women with AF on a nationwide level.…”

Section: Discussionmentioning

confidence: 99%

Temporal trends of gender disparities in oral anticoagulant use in patients with atrial fibrillation

Teppo,

Airaksinen,

Jaakkola

et al. 2023

Eur J Clin Investigation

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AimsTo investigate sex‐specific temporal trends in the initiation of oral anticoagulant (OAC) therapy among patients diagnosed with atrial fibrillation (AF) in Finland between 2007 and 2018.MethodsThe registry‐linkage Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) Study included all patients with incident AF in Finland from 2007 to 2018. The primary outcome was the initiation of any OAC therapy.ResultsWe identified 229,565 patients with new‐onset AF (50.0% women; mean age 72.7 years). The initiation of OAC therapy increased continuously during the observation period. While women were more likely to receive OAC therapy overall, after adjusting for age, stroke risk factors and other confounding factors, female sex was associated with a marginally lower initiation of OACs (unadjusted and adjusted hazard ratios comparing women to men: 1.08 (1.07–1.10) and 0.97 (0.96–0.98), respectively). Importantly, the gender disparities in OAC use attenuated and reached parity by the end of the observation period. Furthermore, when only patients eligible for OAC therapy according to the contemporary guidelines were included in the analyses, the gender inequalities in OAC initiation appeared minimal. Implementation of direct OACs for stroke prevention was slightly slower among women.ConclusionThis nationwide retrospective cohort study covering all patients with incident AF in Finland from 2007 to 2018 observed that although female sex was initially associated with a lower initiation of OAC therapy, the sex‐related disparities resolved over the course of the study period.

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“…These findings may overall represent suboptimal management of hemostasis in women. Previous work suggests women with valvular atrial fibrillation are prescribed oral anticoagulation less frequently than men 67 which may also translate to other cardiovascular conditions. Moreover, women may have a hypercoagulable state that is hypothesized to relate to intrinsic sex‐specific and hormonal risk factors 27 .…”

Section: Discussionmentioning

confidence: 99%

Sex disparities in left ventricular assist device implantation outcomes: A systematic review and meta‐analysis of over 50 000 patients

et al. 2022

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Background: Left ventricular assist devices (LVAD) represent an important therapeutic option for patients progressing to end-stage heart failure. Women have been historically underrepresented in LVAD studies, and have been reported to have worse outcomes despite technological optimisation. We aimed to systematically explore the evidence on sex disparities in the use and outcomes of LVAD implantation. Methods:A systematic database search with meta-analysis was conducted of comparative original articles of men versus women undergoing LVAD implantation, in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to July 2022. Primary outcomes were stroke (haemorrhagic and ischaemic) and early/overall mortality. Secondary outcomes were LVAD thrombosis, right VAD implantation, major bleeding, kidney dysfunction, and device/driveline infection.Results: Our search yielded 137 relevant studies, including 22 meeting the inclusion criteria with a total of 53 227 patients (24.2% women). Overall mortality was higher in women (odds ratio [OR] 1.35, 95% confidence interval [CI] 1.05-1.62, p = 0.02), as was overall stroke (OR 1.32, 95%CI 1.06-1.66, p = 0.01), including ischemic (OR 1.80, 95%CI 1.22-2.64, p = 0.003) and haemorrhagic (OR 1.72, 95%CI 1.09-2.70, p = 0.02). Women had more frequent right VAD implantation (OR 2.11, 95%CI 1.24-3.57, p = 0.006) and major bleeding (OR 1.40, 95%CI 1.06-1.85, p = 0.02). Kidney dysfunction, LVAD thrombosis, and device/driveline infections were comparable between sexes. Conclusions:Our analysis suggests that women face a greater risk of adverse events and mortality post-LVAD implantation. Although the mechanisms remain unclear, the difference in outcomes is thought to be multifactorial. Further research, that includes comprehensive pre-operative characteristics and postoperative outcomes, is encouraged.

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Sex Differences in the Management of Oral Anticoagulation and Outcomes for Emergency Department Presentation of Incident Atrial Fibrillation

Cited by 13 publications

References 44 publications

Trends of use and factors that determine the choice of oral anticoagulants in women and men with atrial fibrillation

Trends of use and factors that determine the choice of oral anticoagulants in women and men with atrial fibrillation

Temporal trends of gender disparities in oral anticoagulant use in patients with atrial fibrillation

Sex disparities in left ventricular assist device implantation outcomes: A systematic review and meta‐analysis of over 50 000 patients

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