title: Does sex affect anticoagulant use for stroke prevention in nonvalvular atrial fibrillation? The prospective global anticoagulant registry in the FIELD-Atrial Fibrillation.
abstract: BACKGROUND
  Among patients with atrial fibrillation (AF), women are at higher risk of stroke than men. Using prospective cohort data from a large global population of patients with nonvalvular AF, we sought to identify any differences in the use of anticoagulants for stroke prevention in women and men.
  
  
  RESULTS
  This was a prospective multicenter observational registry with 858 randomly selected sites in 30 countries. A total of 17 184 patients with newly diagnosed (≤6 weeks) nonvalvular AF and ≥1 additional investigator-defined stroke risk factor(s) were recruited (March 2010 to June 2013). The main outcome measure was the use of anticoagulants (vitamin K antagonists, factor Xa inhibitors, and direct thrombin inhibitors) for stroke prevention at AF diagnosis. Of 17 184 patients enrolled, 43.8% were women. More women than men were at moderate-to-high risk of stroke (CHADS2 score ≥2: 65.1% versus 54.7%). Rates of anticoagulant use were not different overall (60.9% of men versus 60.8% of women) and in patients with a CHADS2 score ≥2 (adjusted odds ratio for women versus men, 1.00; 95% confidence interval, 0.92-1.09). In patients at low risk (CHA2DS2-VASc of 0 in men and 1 in women), 41.8% of men and 41.1% of women received an anticoagulant. In patients at high risk (CHA2DS2-VASc score ≥2), 35.4% of men and 38.4% of women did not receive an anticoagulant.
  
  
  CONCLUSIONS
  These contemporary global data show that anticoagulant use for stroke prevention is no different in men and women with nonvalvular AF. Thromboprophylaxis was, however, suboptimal in substantial proportions of men and women, with underuse in those at moderate-to-high risk of stroke and overuse in those at low risk.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT01090362.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.forename: Sophie K
authors.initials: SK
authors.lastname: Rushton-Smith
authors.forename: Samuel Z
authors.initials: SZ
authors.lastname: Goldhaber
authors.forename: David A
authors.initials: DA
authors.lastname: Fitzmaurice
authors.forename: Lorenzo G
authors.initials: LG
authors.lastname: Mantovani
authors.forename: Shinya
authors.initials: S
authors.lastname: Goto
authors.forename: Sylvia
authors.initials: S
authors.lastname: Haas
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Bassand
authors.forename: Alan John
authors.initials: AJ
authors.lastname: Camm
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ambrosio
authors.forename: Petr
authors.initials: P
authors.lastname: Janský
authors.forename: Wael
authors.initials: W
authors.lastname: Al Mahmeed
authors.forename: Seil
authors.initials: S
authors.lastname: Oh
authors.forename: Martin
authors.initials: M
authors.lastname: van Eickels
authors.forename: Pekka
authors.initials: P
authors.lastname: Raatikainen
authors.forename: Jan
authors.initials: J
authors.lastname: Steffel
authors.forename: Ali
authors.initials: A
authors.lastname: Oto
authors.forename: Gloria
authors.initials: G
authors.lastname: Kayani
authors.forename: Gabriele
authors.initials: G
authors.lastname: Accetta
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Kakkar
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents
keywords: atrial fibrillation; embolism; sex; stroke; women