Does sex affect anticoagulant use for stroke prevention in nonvalvular atrial fibrillation? The prospective global anticoagulant registry in the FIELD-Atrial Fibrillation

GARFIELD-AF Investigators

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Abstract

Background.Among patients with atrial fibrillation (AF), women are at higher risk of stroke than men. Using prospective cohort data from a large global population of patients with nonvalvular AF, we sought to identify any differences in the use of anticoagulants for stroke prevention in women and men. Methods and Results.This was a prospective multicenter observational registry with 858 randomly selected sites in 30 countries. A total of 17 184 patients with newly diagnosed (.6 weeks) nonvalvular AF and .1 additional investigatordefined stroke risk factor(s) were recruited (March 2010 to June 2013). The main outcome measure was the use of anticoagulants (Vitamin K antagonists, factor Xa inhibitors, and direct thrombin inhibitors) for stroke prevention at AF diagnosis. Of 17 184 patients enrolled, 43.8% were women. More women than men were at moderate-to-high risk of stroke (CHADS2 score .2: 65.1% versus 54.7%). Rates of anticoagulant use were not different overall (60.9% of men versus 60.8% of women) and in patients with a CHADS2 score .2 (adjusted odds ratio for women versus men, 1.00; 95% confidence interval, 0.92.1.09). In patients at low risk (CHA2DS2-VASc of 0 in men and 1 in women), 41.8% of men and 41.1% of women received an anticoagulant. In patients at high risk (CHA2DS2-VASc score .2), 35.4% of men and 38.4% of women did not receive an anticoagulant. Conclusions.These contemporary global data show that anticoagulant use for stroke prevention is no different in men and women with nonvalvular AF. Thromboprophylaxis was, however, suboptimal in substantial proportions of men and women, with underuse in those at moderate-to-high risk of stroke and overuse in those at low risk.

Original languageEnglish
Pages (from-to)S12-S20
JournalCirculation: Cardiovascular Quality and Outcomes
Volume8
DOIs
Publication statusPublished - 2015 Mar 1

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Anticoagulants
Atrial Fibrillation
Registries
Stroke
Antithrombins
Vitamin K
Odds Ratio
Outcome Assessment (Health Care)
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

@article{fc1d3b320bf9461c9afabbf3267c6413,
title = "Does sex affect anticoagulant use for stroke prevention in nonvalvular atrial fibrillation?: The prospective global anticoagulant registry in the FIELD-Atrial Fibrillation",
abstract = "Background.Among patients with atrial fibrillation (AF), women are at higher risk of stroke than men. Using prospective cohort data from a large global population of patients with nonvalvular AF, we sought to identify any differences in the use of anticoagulants for stroke prevention in women and men. Methods and Results.This was a prospective multicenter observational registry with 858 randomly selected sites in 30 countries. A total of 17 184 patients with newly diagnosed (.6 weeks) nonvalvular AF and .1 additional investigatordefined stroke risk factor(s) were recruited (March 2010 to June 2013). The main outcome measure was the use of anticoagulants (Vitamin K antagonists, factor Xa inhibitors, and direct thrombin inhibitors) for stroke prevention at AF diagnosis. Of 17 184 patients enrolled, 43.8{\%} were women. More women than men were at moderate-to-high risk of stroke (CHADS2 score .2: 65.1{\%} versus 54.7{\%}). Rates of anticoagulant use were not different overall (60.9{\%} of men versus 60.8{\%} of women) and in patients with a CHADS2 score .2 (adjusted odds ratio for women versus men, 1.00; 95{\%} confidence interval, 0.92.1.09). In patients at low risk (CHA2DS2-VASc of 0 in men and 1 in women), 41.8{\%} of men and 41.1{\%} of women received an anticoagulant. In patients at high risk (CHA2DS2-VASc score .2), 35.4{\%} of men and 38.4{\%} of women did not receive an anticoagulant. Conclusions.These contemporary global data show that anticoagulant use for stroke prevention is no different in men and women with nonvalvular AF. Thromboprophylaxis was, however, suboptimal in substantial proportions of men and women, with underuse in those at moderate-to-high risk of stroke and overuse in those at low risk.",
author = "{GARFIELD-AF Investigators} and Lip, {Gregory Y.H.} and Rushton-Smith, {Sophie K.} and Goldhaber, {Samuel Z.} and Fitzmaurice, {David A.} and Mantovani, {Lorenzo G.} and Shinya Goto and Sylvia Haas and Bassand, {Jean Pierre} and Camm, {Alan John} and Giuseppe Ambrosio and Petr Jansk{\'y} and {Al Mahmeed}, Wael and Seil Oh and {Van Eickels}, Martin and Pekka Raatikainen and Jan Steffel and Ali Oto and Gloria Kayani and Gabriele Accetta and Kakkar, {Ajay K.} and S. Goto and W. Hacke and F. Misselwitz and Turpie, {A. G.} and Verheugt, {F. W.} and Fox, {K. A.} and Gersh, {B. J.} and Luciardi, {H. L.} and F. Cools and R. Corbalan and M. Keltai and S. Kakkar and E. Panchenko and Lim, {T. W.} and B. Jacobson and P. Angchaisuksiri and A. Parkhomenko and Barretto, {A. C.} and {S{\'a}nchez D{\'i}az}, {C. J.} and D. Atar and D. Hu and G. Agnelli and H. Darius and H. Gibbs and {Ten Cate}, H. and J. Stepinska and {Le Heuzey}, {J. Y.} and Nielsen, {J. D.} and M. Brodmann and M. Rosenqvist",
year = "2015",
month = "3",
day = "1",
doi = "10.1161/CIRCOUTCOMES.114.001556",
language = "English",
volume = "8",
pages = "S12--S20",
journal = "Circulation: Cardiovascular Quality and Outcomes",
issn = "1941-7713",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Does sex affect anticoagulant use for stroke prevention in nonvalvular atrial fibrillation?

T2 - The prospective global anticoagulant registry in the FIELD-Atrial Fibrillation

AU - GARFIELD-AF Investigators

AU - Lip, Gregory Y.H.

AU - Rushton-Smith, Sophie K.

AU - Goldhaber, Samuel Z.

AU - Fitzmaurice, David A.

AU - Mantovani, Lorenzo G.

AU - Goto, Shinya

AU - Haas, Sylvia

AU - Bassand, Jean Pierre

AU - Camm, Alan John

AU - Ambrosio, Giuseppe

AU - Janský, Petr

AU - Al Mahmeed, Wael

AU - Oh, Seil

AU - Van Eickels, Martin

AU - Raatikainen, Pekka

AU - Steffel, Jan

AU - Oto, Ali

AU - Kayani, Gloria

AU - Accetta, Gabriele

AU - Kakkar, Ajay K.

AU - Goto, S.

AU - Hacke, W.

AU - Misselwitz, F.

AU - Turpie, A. G.

AU - Verheugt, F. W.

AU - Fox, K. A.

AU - Gersh, B. J.

AU - Luciardi, H. L.

AU - Cools, F.

AU - Corbalan, R.

AU - Keltai, M.

AU - Kakkar, S.

AU - Panchenko, E.

AU - Lim, T. W.

AU - Jacobson, B.

AU - Angchaisuksiri, P.

AU - Parkhomenko, A.

AU - Barretto, A. C.

AU - Sánchez Díaz, C. J.

AU - Atar, D.

AU - Hu, D.

AU - Agnelli, G.

AU - Darius, H.

AU - Gibbs, H.

AU - Ten Cate, H.

AU - Stepinska, J.

AU - Le Heuzey, J. Y.

AU - Nielsen, J. D.

AU - Brodmann, M.

AU - Rosenqvist, M.

PY - 2015/3/1

Y1 - 2015/3/1

N2 - Background.Among patients with atrial fibrillation (AF), women are at higher risk of stroke than men. Using prospective cohort data from a large global population of patients with nonvalvular AF, we sought to identify any differences in the use of anticoagulants for stroke prevention in women and men. Methods and Results.This was a prospective multicenter observational registry with 858 randomly selected sites in 30 countries. A total of 17 184 patients with newly diagnosed (.6 weeks) nonvalvular AF and .1 additional investigatordefined stroke risk factor(s) were recruited (March 2010 to June 2013). The main outcome measure was the use of anticoagulants (Vitamin K antagonists, factor Xa inhibitors, and direct thrombin inhibitors) for stroke prevention at AF diagnosis. Of 17 184 patients enrolled, 43.8% were women. More women than men were at moderate-to-high risk of stroke (CHADS2 score .2: 65.1% versus 54.7%). Rates of anticoagulant use were not different overall (60.9% of men versus 60.8% of women) and in patients with a CHADS2 score .2 (adjusted odds ratio for women versus men, 1.00; 95% confidence interval, 0.92.1.09). In patients at low risk (CHA2DS2-VASc of 0 in men and 1 in women), 41.8% of men and 41.1% of women received an anticoagulant. In patients at high risk (CHA2DS2-VASc score .2), 35.4% of men and 38.4% of women did not receive an anticoagulant. Conclusions.These contemporary global data show that anticoagulant use for stroke prevention is no different in men and women with nonvalvular AF. Thromboprophylaxis was, however, suboptimal in substantial proportions of men and women, with underuse in those at moderate-to-high risk of stroke and overuse in those at low risk.

AB - Background.Among patients with atrial fibrillation (AF), women are at higher risk of stroke than men. Using prospective cohort data from a large global population of patients with nonvalvular AF, we sought to identify any differences in the use of anticoagulants for stroke prevention in women and men. Methods and Results.This was a prospective multicenter observational registry with 858 randomly selected sites in 30 countries. A total of 17 184 patients with newly diagnosed (.6 weeks) nonvalvular AF and .1 additional investigatordefined stroke risk factor(s) were recruited (March 2010 to June 2013). The main outcome measure was the use of anticoagulants (Vitamin K antagonists, factor Xa inhibitors, and direct thrombin inhibitors) for stroke prevention at AF diagnosis. Of 17 184 patients enrolled, 43.8% were women. More women than men were at moderate-to-high risk of stroke (CHADS2 score .2: 65.1% versus 54.7%). Rates of anticoagulant use were not different overall (60.9% of men versus 60.8% of women) and in patients with a CHADS2 score .2 (adjusted odds ratio for women versus men, 1.00; 95% confidence interval, 0.92.1.09). In patients at low risk (CHA2DS2-VASc of 0 in men and 1 in women), 41.8% of men and 41.1% of women received an anticoagulant. In patients at high risk (CHA2DS2-VASc score .2), 35.4% of men and 38.4% of women did not receive an anticoagulant. Conclusions.These contemporary global data show that anticoagulant use for stroke prevention is no different in men and women with nonvalvular AF. Thromboprophylaxis was, however, suboptimal in substantial proportions of men and women, with underuse in those at moderate-to-high risk of stroke and overuse in those at low risk.

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U2 - 10.1161/CIRCOUTCOMES.114.001556

DO - 10.1161/CIRCOUTCOMES.114.001556

M3 - Article

C2 - 25714828

AN - SCOPUS:84942123297

VL - 8

SP - S12-S20

JO - Circulation: Cardiovascular Quality and Outcomes

JF - Circulation: Cardiovascular Quality and Outcomes

SN - 1941-7713

ER -