Inadequate oral anticoagulation with warfarin in women with cerebrovascular event and history of atrial fibrillation: the FibStroke study. (1st January 2021)

• Record Type: Journal Article
• Authors: Bah, Aissa; Nuotio, Ilpo; Palomäki, Antti; Mustonen, Pirjo; Kiviniemi, Tuomas; Ylitalo, Antti; Hartikainen, Päivi; Airaksinen, K. E. Juhani; Hartikainen, Juha E. K.
• Is Part Of: Annals of medicine. Volume 53:Number 1(2021)
• Page Start: 287
• Page End: 294
• Publication Date: 2021-01-01
• Subjects: Atrial fibrillation (AF) -- oral anticoagulation (OAC) -- CHADS2 -- CHA2DS2-VASc -- sex; Medicine -- Periodicals; 610
• DOI: 10.1080/07853890.2021.1875499
• Languages: English
• ISSNs: 0785-3890

Abstract

Abstract: Background: Women with atrial fibrillation (AF) may be treated less actively with oral anticoagulation (OAC) than men. Patients and methods: We assessed sex differences in the implementation of stroke risk stratification with CHADS2 and CHA2 DS2 -VASc scores and reasons not to use OAC in 1747 AF patients suffering their first cerebrovascular event after the AF diagnosis. Results: Women were older and had more often a high stroke risk (CHADS2 /CHA2 DS2 -VASc ≥2) than men ( p < .001). On admission, 46.4% of women and 48.2% of men were on OAC with no sex difference ( p = .437). However, of patients without OAC, 74.4% of women and 49.5% of men should have been on OAC based on CHADS2 /CHA2 DS2 -VASc ≥2 ( p < .001). Conversely, 34.8% of men and 17.5% of women on OAC had a low or moderate risk (CHADS2 /CHA2 DS2 -VASc 0–1, p < .001). A valid reason to omit OAC was reported in 38.6% of patients and less often in women ( p < .001). Conclusions: OAC was underused in high-risk AF patients, particularly women, but prescribed often in men with low or moderate stroke risk. Reasons for omitting OAC treatment were poorly reported, particularly for women. KEY MESSAGE: Women were at higher stroke risk, but were less often treated with oral anticoagulation (OAC). Men were more often on OAC at low or moderate stroke risk. Reasons for omitting guideline based OAC were poorly reported, particularly for women.