title: Meta-analysis of gender differences in residual stroke risk and major bleeding in patients with nonvalvular atrial fibrillation treated with oral anticoagulants.
abstract: Studies comparing gender-specific outcomes in patients with atrial fibrillation (AF) have reported conflicting results. Gender differences in cerebrovascular accident/systemic embolism (CVA/SE) or major bleeding outcomes with novel oral anticoagulant (NOAC) use are not known. The goal of this analysis was to perform a systematic review and meta-analysis evaluating gender differences in residual risk of CVA/SE and major bleeding outcomes in patients with nonvalvular AF treated with either warfarin or NOAC. Sixty-four randomized studies were identified using keywords "gender," "AF," and "CVA." Using the Preferred Reporting Items for Systemic Reviews and Meta-analysis method, 6 studies met criteria for inclusion in this meta-analysis. CVA/SE and major bleeding outcomes were separately analyzed in cohorts receiving warfarin and NOAC agents, comparing men with women. Women with AF taking warfarin were at a significantly greater residual risk of CVA/SE compared with men (odds ratio 1.279, 95% confidence interval 1.111 to 1.473, Z = -3.428, p = 0.001). No gender difference in residual risk of CVA/SE was noted in patients with AF receiving NOAC agents (odds ratio 1.146, 95% confidence interval 0.97 to 1.354, p = 0.109). Major bleeding was less frequent in women with AF treated with NOAC. In conclusion, women with AF treated with warfarin have a greater residual risk of CVA/SE and an equivalent major bleeding risk, whereas those treated with NOAC agents deemed superior to warfarin are at equivalent residual risk of CVA/SE and less major bleeding risk compared with men. These results suggest an increased net clinical benefit of NOAC agents compared with warfarin in treating women with AF.
authors: Department of Medicine and Cardiology, The Wright Center for Graduate Medical Center, Scranton, Pennsylvania. Electronic address: pancholys@gmail.com.
authors: Samir B
authors: SB
authors: Pancholy
authors: Department of Medicine and Cardiology, The Wright Center for Graduate Medical Center, Scranton, Pennsylvania.
authors: Parikshit S
authors: PS
authors: Sharma
authors: Department of Medicine and Cardiology, The Wright Center for Graduate Medical Center, Scranton, Pennsylvania.
authors: Dipti S
authors: DS
authors: Pancholy
authors: Department of Cardiology, Seth N.H.L. Municipal Medical College, Ahmedabad, India.
authors: Tejas M
authors: TM
authors: Patel
authors: Department of Cardiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors: David J
authors: DJ
authors: Callans
authors: Department of Cardiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Francis E
authors: FE
authors: Marchlinski
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D005260:Female; D014943:Global Health; D006470:Hemorrhage / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control
chemical_list: D000925:Anticoagulants