Sex differences in patients receiving anticoagulant therapy for venous thromboembolism.
In patients with venous thromboembolism (VTE), the outcome during the course of anticoagulant therapy may differ according to the patient's sex. We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to compare the rate of VTE recurrences, major bleeding, and mortality due to these events according to sex.As of August 2013, 47,499 patients were enrolled in RIETE, of whom 24,280 (51%) were women. Women were older, more likely presented with pulmonary embolism (PE), and were more likely to have recent immobilization but less likely to have cancer than men. During the course of anticoagulation (mean duration: 253 d), 659 patients developed recurrent deep vein thrombosis (DVT), 576 recurrent PE, 1368 bled, and 4506 died. Compared with men, women had a lower rate of DVT recurrences (hazard ratio [HR]: 0.78; 95% confidence interval [CI]: 0.67-0.91), a similar rate of PE recurrences (HR: 0.98; 95% CI: 0.83-1.15), a higher rate of major bleeding (HR: 1.21; 95% CI: 1.09-1.35), and higher mortality due to PE (HR: 1.24; 95% CI: 1.04-1.47). On multivariable analysis, any influence of sex on the risk for recurrent DVT (HR: 0.88; 95% CI: 0.75-1.03), major bleeding (HR: 1.10; 95% CI: 0.98-1.24), or fatal PE (HR: 1.01; 95% CI: 0.84-1.22) was no longer statistically significant.In conclusion, women had fewer DVT recurrences and more bleeds than men during the course of anticoagulation. These differences were not due to sex, but very likely to other patient characteristics more common in female patients and differences in treatment choice.
From Department of Internal Medicine (ABM), Hospital Universitario Reina Sofia, Córdoba, Spain; Department of Emergency Medicine, Ospedale San Sebastiano, Caserta, Italy; Department of Haematology and Hemotherapy (TG), Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil; Department of Clinical and Experimental Medicine (AT), Università degli Studi di Napoli Federico II, Naples, Italy; Department of Vascular Medicine (ABR), Hôpital de Rangueil, Toulouse, France; Department of Internal Medicine (PDM), Ospedale Buonconsiglio Fatebenefratelli, Naples, Italy; Division of Angiology and Haemostasis (HB), University Hospital of Geneva, Geneva, Switzerland; Department of Internal Medicine (JG), ALTHAIA, Xarxa Assistencial de Manresa, Spain; Department of Internal Medicine (JV), Hospital Clinic, Barcelona, Spain; and Department of Internal Medicine (MM), Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
Angeles
A
Blanco-Molina
Iolanda
I
Enea
Telma
T
Gadelha
Antonella
A
Tufano
Alessandra
A
Bura-Riviere
Pierpaolo
P
Di Micco
Henri
H
Bounameaux
José
J
González
Jaume
J
Villalta
Manuel
M
Monreal
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000401:mortality; D012008:Recurrence; D012737:Sex Factors; D054556:Venous Thromboembolism / Q000188:drug therapy* / Q000401:mortality
D000925:Anticoagulants