Circulation. 2005;112:1687-1691
Published online before print September 12, 2005, doi: 10.1161/CIRCULATIONAHA.105.553438
Published online before print September 12, 2005, doi: 10.1161/CIRCULATIONAHA.105.553438
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(Circulation. 2005;112:1687-1691.)
© 2005 American Heart Association, Inc.
Arrhythmia/Electrophysiology |
Gender Differences in the Risk of Ischemic Stroke and Peripheral Embolism in Atrial Fibrillation
The AnTicoagulation and Risk factors In Atrial fibrillation (ATRIA) Study
From the University of California, San Francisco (M.C.F., A.S.G.); Clinical Epidemiology Unit, Massachusetts General Hospital, Boston (D.E.S., Y.C., L.E.H.); General Internal Medicine and Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Mass (E.M.H.); and Division of Research, Kaiser Permanente of Northern California, Oakland (N.G.J., A.S.G.).
Correspondence to Margaret C. Fang, MD, MPH, Department of Medicine, Hospitalist Group, University of California, San Francisco, 533 Parnassus Ave, Box 0131, San Francisco, CA 94143. E-mail mfang{at}medicine.ucsf.edu
Received April 4, 2005; revision received May 24, 2005; accepted June 2, 2005.
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.
Key Words: anticoagulants • atrial fibrillation • risk factors • stroke • women
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