Meta-analysis of gender differences in residual stroke risk and major bleeding in patients with nonvalvular atrial fibrillation treated with oral anticoagulants.

Abstract

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.

• Authors: Samir B Pancholy, Parikshit S Sharma, Dipti S Pancholy, Tejas M Patel, David J Callans, Francis E Marchlinski
• Journal: The American journal of cardiology (Am J Cardiol) Vol. 113 Issue 3 Pg. 485-90 (Feb 01 2014) ISSN: 1879-1913 [Electronic] United States
• PMID: 24315113 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Chemical References

• Anticoagulants

Topics

• Anticoagulants (therapeutic use)
• Atrial Fibrillation (complications, drug therapy)
• Female
• Global Health
• Hemorrhage (epidemiology, etiology, prevention & control)
• Humans
• Incidence
• Male
• Prognosis
• Risk Factors
• Sex Distribution
• Sex Factors
• Stroke (epidemiology, etiology, prevention & control)