To assess the quality of INR control in 2015 in atrial fibrillation patients treated with Vitamin K Antagonists (VKA) for stroke prevention in the region of Valencia, Spain, and to identify factors associated with poor control. To quantify switching to direct oral anticoagulants (DOAC) during 2016 and to identify factors associated to switching. Analyses were performed for the whole population and stratified by gender. Cross-sectional, population-based study. Information was obtained through linking different regional electronic databases. Outcome measures were Time in Therapeutic Range (TTR) and percentage of INR determinations in range (PINRR) in 2015, and percentage of switching to DOAC in 2016. We included 22,629 patients, 50.4% were women. Mean TTR was 62.3% for women and 63.7% for men, and PINNR was 58.3% for women and 60.1% for men (p<0,001). Considering the TTR<65% threshold, 53% of women and 49.3% of men had poor anticoagulation control (p<0,001). Women, antiplatelet users and high risk patients were more likely to present poor INR control. 5,4% of poorly controlled patients during 2015 switched to a DOAC throughout 2016, with no differences between genders. The quality of INR control of all AF patients treated with VKA for stroke prevention in 2015 in our Southern European region was suboptimal, and women were at a higher risk of poor INR control. This reflects gender disparities in care, and programs for improving the quality of oral anticoagulation should incorporate the gender perspective. Observed low rates of switching suggest strong clinical inertia.