Meta-Analysis of Gender Differences in Residual Stroke Risk and Major Bleeding in Patients With Nonvalvular Atrial Fibrillation Treated With Oral Anticoagulants

• Published in: The American journal of cardiology 2014-02, Vol.113 (3), p.485-490
• Main Authors: Pancholy, Samir B., MD, Sharma, Parikshit S., MD, Pancholy, Dipti S., MD, Patel, Tejas M., MD, Callans, David J., MD, Marchlinski, Francis E., MD
• Format: Article
• Language: English
• Subjects: Anticoagulants; Anticoagulants - therapeutic use; Atrial Fibrillation - complications; Atrial Fibrillation - drug therapy; Cardiac arrhythmia; Cardiovascular; Drug therapy; Female; Gender differences; Global Health; Hemorrhage - epidemiology; Hemorrhage - etiology; Hemorrhage - prevention & control; Humans; Incidence; Male; Prognosis; Risk Factors; Sex Distribution; Sex Factors; Stroke; Stroke - epidemiology; Stroke - etiology; Stroke - prevention & control
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2013.10.035

Studies comparing gender-specific outcomes in patients with atrial fibrillation (AF) have reported conflicting results. Gender differences in cerebrovascular accident/systemic embolism (CVA/SE) or major bleeding outcomes with novel oral anticoagulant (NOAC) use are not known. The goal of this analysis was to perform a systematic review and meta-analysis evaluating gender differences in residual risk of CVA/SE and major bleeding outcomes in patients with nonvalvular AF treated with either warfarin or NOAC. Sixty-four randomized studies were identified using keywords “gender,” “AF,” and “CVA.” Using the Preferred Reporting Items for Systemic Reviews and Meta-analysis method, 6 studies met criteria for inclusion in this meta-analysis. CVA/SE and major bleeding outcomes were separately analyzed in cohorts receiving warfarin and NOAC agents, comparing men with women. Women with AF taking warfarin were at a significantly greater residual risk of CVA/SE compared with men (odds ratio 1.279, 95% confidence interval 1.111 to 1.473, Z = −3.428, p = 0.001). No gender difference in residual risk of CVA/SE was noted in patients with AF receiving NOAC agents (odds ratio 1.146, 95% confidence interval 0.97 to 1.354, p = 0.109). Major bleeding was less frequent in women with AF treated with NOAC. In conclusion, women with AF treated with warfarin have a greater residual risk of CVA/SE and an equivalent major bleeding risk, whereas those treated with NOAC agents deemed superior to warfarin are at equivalent residual risk of CVA/SE and less major bleeding risk compared with men. These results suggest an increased net clinical benefit of NOAC agents compared with warfarin in treating women with AF.