Gender and the risk of stroke in atrial fibrillation: impact of old and new anticoagulation regimens

Abstract

Atrial fibrillation (AF) is the most common sustained arrhythmia. Thromboembolic events related to AF result in significant morbidity and mortality. An individual’s risk of thromboembolism in the setting of AF varies significantly based on clinical and demographic characteristics. The risk of stroke appears to be greater among women with AF than men. Warfarin provides sufficient protection against stroke, but does not eliminate gender differences in stroke rates. New oral anticoagulants demonstrated similar or superior efficacy compared to warfarin; however rates of stroke in women on new agents remain higher than those observed in men. In the present article, we review the reported gender-related differences in stroke rates in both anticoagulated and nonanticoagulated patient populations. We also focus on differences in stroke and bleeding rates among men and women treated with new oral anticoagulants. Finally, we explore potential sex-based differences in the efficacy and safety of new oral anticoagulants as reflected in the results of the landmark phase III trials.