Sex Differences in the Use of Oral Anticoagulants for Atrial Fibrillation: A Report From the National Cardiovascular Data Registry (NCDR(®)) PINNACLE Registry.
Sex Differences in the Use of Oral Anticoagulants for Atrial Fibrillation: A Report From the National Cardiovascular Data Registry (NCDR(®)) PINNACLE Registry.
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DOI：
10.1161/jaha.117.005801
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发表时间：
2017-07-19
影响因子：
5.4
通讯作者：
Daugherty SL
中科院分区：
文献类型：
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作者：
Thompson LE;Maddox TM;Lei L;Grunwald GK;Bradley SM;Peterson PN;Masoudi FA;Turchin A;Song Y;Doros G;Davis MB;Daugherty SL
尽管血栓栓塞风险较高，但与男性相比，女性房颤患者口服抗凝剂（OAC）的使用率较低。CHA 2 DS 2‐VASc评分或引入非维生素K OAC对这种关系的影响尚不清楚。使用2008年至2014年的PINNACLE国家心血管数据登记研究，我们比较了性别与OAC使用（华法林或非维生素K OAC）的总体相关性和CHA 2 DS 2‐VASc评分，并按性别检查了OAC使用的时间趋势。多变量回归模型评估了CHA 2 DS 2‐VASc评分≥2的患者中性别与OAC使用之间的相关性。时间分析评估了按性别划分的OAC使用随时间的变化。在691906例房颤患者中，48.5%为女性。总体而言，女性使用任何OAC的可能性均显著低于男性（56.7% vs 61.3%; P<0.001），并且在所有CHA 2 DS 2‐VASc评分水平上（校正风险比低9%至33%，所有P<0.001）。与其他血栓栓塞风险因素相比，女性与OAC使用率较低相关（风险比0.90，95%CI 0.90 - 0.91）。随着时间的推移，女性非维生素K OAC的使用率（每年增加56.2%，95%CI 54.6%至57.9%）略高于男性（每年增加53.6%，95%CI 52.0%至55.2%），但女性在所有时间点接受任何OAC的可能性仍然较低（P<0.001）。在房颤患者中，在CHA 2 DS 2‐VASc评分的所有水平上，女性接受OAC的可能性均显著降低。尽管非维生素K OAC的使用越来越多，但随着时间的推移，女性的OAC使用率始终低于男性。
Despite higher thromboembolism risk, women with atrial fibrillation have lower oral anticoagulation (OAC) use compared to men. The influence of the CHA 2 DS 2‐VASc score or the introduction of non–vitamin K OACs on this relationship is not known. Using the PINNACLE National Cardiovascular Data Registry from 2008 to 2014, we compared the association of sex with OAC use (warfarin or non–vitamin K OACs) overall and by CHA 2 DS 2‐VASc score and examined temporal trends in OAC use by sex. Multivariable regression models assessed the association between sex and OAC use in those with CHA 2 DS 2‐VASc scores ≥2. Temporal analyses assessed changes in OAC use by sex over time. Of the 691 906 atrial fibrillation patients, 48.5% were women. Women were significantly less likely than men to use any OAC overall (56.7% versus 61.3%; P<0.001) and at all levels of CHA 2 DS 2‐VASc score (adjusted risk ratio 9% to 33% lower, all P<0.001). Compared to other thromboembolic risk factors, female sex was associated with lower use of OAC (risk ratio 0.90, 95%CI 0.90‐0.91). Over time, non–vitamin K OAC use increased at a slightly higher rate in women (56.2% increase per year, 95%CI 54.6% to 57.9%) compared to men (53.6% increase per year, 95%CI 52.0% to 55.2%), yet women remained less likely to receive any OAC at all time points (P<0.001). Among patients with atrial fibrillation, women were significantly less likely to receive OAC at all levels of the CHA 2 DS 2‐VASc score. Despite increasing non–vitamin K OAC use, women had persistently lower rates of OAC use compared to men over time.