Gender differences in stroke risk of atrial fibrillation patients on oral anticoagulant treatment
Gender differences in stroke risk of atrial fibrillation patients on oral anticoagulant treatment
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DOI：
10.1160/th08-10-0635
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发表时间：
2009-05-01
影响因子：
6.7
通讯作者：
Prisco, Domenico
中科院分区：
文献类型：
--
作者：
Poli, Daniela;Antonucci, Emilia;Prisco, Domenico
调整剂量的口服抗凝剂治疗（OAT）在预防房颤（AF）患者卒中方面的有效性已得到充分证实。现有数据显示，AF患者在缺血性卒中风险方面存在广泛异质性。女性作为卒中风险预测因子的作用不一致，特别是华法林治疗是否能够在两性中同等预防卒中尚不清楚。我们对780例接受OAT的AF患者进行了一项前瞻性研究，随后在抗凝门诊进行了研究，以评估女性是否是接受OAT患者卒中的风险因素，以及性别之间的抗凝质量是否存在差异。性别之间的抗凝质量无差异（p=0.5）。在随访期间，33例患者发生了严重的眼睑下垂（发生率为1.37 x 100例患者/年），但在出血风险方面没有发现性别差异。40例患者发生缺血性事件[发生率为1.66 x 100例患者/年;男性发生率为1.2 x 100例患者/年;女性发生率为2.43 x 100例患者/年; p=0.042;女性与男性的相对风险（RR）为2.0（95%置信区间[CI] 1.3-3.1）; p= 0.004]。校正年龄后，在考克斯回归分析中证实女性的缺血事件发生率高于男性（p=0.009）。此外，女性发生的卒中致残率更高，根据改良兰金量表定义的重度和致死性卒中的RR，女性与男性相比为3.1（95% CI 1.3-6.5; p=0.001）。总之，我们的数据显示，尽管抗凝质量相似，但抗凝房颤女性患者的卒中风险高于男性。
The efficacy of adjusted-dose oral anticoagulant treatment (OAT) in the prevention of stroke in atrial fibrillation (AF) is well documented. Available data show that AF patients are widely heterogeneous in terms of ischaemic stroke risk. The role of female gender as a predictor of stroke risk is inconsistent, in particular it is unclear if warfarin treatment is able to prevent stroke equally in both sexes. We performed a prospective study on 780 AF patients on OAT, followed by an Anticoagulation Clinic, to evaluate if female gender is a risk factor for stroke among patients on OAT and if the quality of anticoagulation is different between genders. No difference was found in relation to the quality of anticoagulation between genders (p=0.5). During follow-up 33 patients had major bleedings (rate 1.37x 100 pt/yrs) but no difference was found between genders in bleeding risk. Forty patients had ischaemic events [rate 1.66x 100 pt/yrs; males rate 1.2 x 100 pt/yrs; females rate 2.43x 100 pt/yrs; p=0.042; relative risk (RR) of females vs. males 2.0 (95% confidence interval [CI] 1.3-3.1); p= 0.004]. The higher rate of ischaemic events in females with respect to males was confirmed at Cox regression analysis after correction for age (p=0.009). In addition, strokes occurring in females were more disabling, and RR for severe and fatal stroke, defined according to Modified Rankin scale, of females vs. males was 3.1 (95% Cl 1.3-6.5; p=0.001). In conclusion, our data show a higher risk of stroke in anticoagulated AF females with respect to males, despite a similar quality of anticoagulation.