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Clinical Research Study| Volume 131, ISSUE 8, P945-955.e3, August 2018

Gender Differences in Antithrombotic Treatment for Newly Diagnosed Atrial Fibrillation: The GLORIA-AF Registry Program

Published:April 11, 2018DOI:https://doi.org/10.1016/j.amjmed.2018.03.024
Gender Differences in Antithrombotic Treatment for Newly Diagnosed Atrial Fibrillation: The GLORIA-AF Registry Program
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      Abstract

      Aims

      Data on gender differences in oral anticoagulation for stroke prevention in patients with atrial fibrillation are conflicting, largely limited to regional reports and vitamin K antagonist use. We aimed to analyze gender-specific anticoagulant prescription patterns early following the introduction of non–vitamin K antagonist oral anticoagulants (NOACs) in a large, global registry on atrial fibrillation.

      Methods

      The Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF) is an international registry program involving patients with newly diagnosed atrial fibrillation (<3 months from arrhythmia onset). We used data from 15,092 consecutive patients (median age, 71.0 years; 45.5% were women) enrolled between 2011 and 2014. Globally, 79.7% of women and 80.2% of men were anticoagulated; the absolute between-gender difference in prevalence of anticoagulant use was −0.5% (95% confidence interval, −1.8% to 0.8%). Vitamin K antagonists were prescribed to 32.8% and 31.9% (NOACs 46.8% and 48.3%) of women and men, respectively.

      Results

      No confounder for the association between gender and anticoagulant prescription was identified. Between-gender differences in anticoagulant use (lower use in women compared with men by decreasing order of magnitude of the difference) were found for CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65-74 years, sex category [female]) score = 1; CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke) score = 0; previous bleeding; age <65 years; no history of hypertension; myocardial infarction; coronary artery disease; North America region; and specialist office setting.

      Conclusion

      Globally, the prevalence of anticoagulant use is similar in women and men. The decision to prescribe oral anticoagulation seems to depend predominantly on guideline-related differences in stroke risk stratification rather than on gender.

      Keywords

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      Article info

      Publication history

      Published online: April 11, 2018

      Footnotes

      Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT01468701.

      Funding: This work was supported by Boehringer Ingelheim GmbH.

      Conflict of Interest: MM declares no conflict of interest. MVH has received honoraria for presentations and research grants from Boehringer Ingelheim, Bayer HealthCare, Pfizer, GlaxoSmithKline (GSK), and Actelion Pharmaceuticals. KJR is an employee of RTI Health Solutions, an independent nonprofit research organization that does work for government agencies and pharmaceutical companies. HCD has received honoraria for participation in clinical trials and contributes to advisory boards or oral presentations from Abbott, Allergan, AstraZeneca, Bayer Vital, BMS, Boehringer Ingelheim, CoAxia, Corimmun, Covidien, Daiichi-Sankyo, D-Pharm, Fresenius, GSK, Janssen-Cilag, Johnson & Johnson, Knoll, Lilly, MSD, Medtronic, MindFrame, Neurobiological Technologies, Novartis, Novo-Nordisk, Paion, Parke-Davis, Pfizer, Sanofi-Aventis, Schering-Plough, Servier, Solvay, St Jude, Syngis, Talecris, Thrombogenics, WebMD Global, Wyeth, and Yamanouchi. Financial support for research projects was provided by AstraZeneca, GSK, Boehringer Ingelheim, Lundbeck, Novartis, Janssen-Cilag, Sanofi-Aventis, Syngis, and Talecris. The Department of Neurology at the University Duisburg-Essen received research grants from the German Research Council (DFG), the German Ministry of Education and Research (BMBF), the European Union, the National Institutes of Health, the Bertelsmann Foundation, and the Heinz-Nixdorf Foundation. HCD has no ownership interest and does not own stocks of any pharmaceutical company; within the past year, HCD served as the editor of Aktuelle Neurologie, Arzneimitteltherapie, Kopfschmerznews, and Stroke News, as the co-editor of Cephalalgia, and was on the editorial board of Lancet Neurology, Stroke, European Neurology and Cerebrovascular Disorders; HCD chairs the Treatment Guidelines Committee of the German Society of Neurology and has contributed to the European Heart Rhythm Association and the European Society of Cardiology guidelines for the treatment of atrial fibrillation. SJD has received consultancy fees for serving as a steering committee member for Boehringer Ingelheim and holds research grants from St Jude Medical. JLH is currently conducting research sponsored by Boehringer Ingelheim as a member of the Executive Steering Committee for the GLORIA-AF Registry and has received consulting fees from Bayer HealthCare, Janssen-Ortho-McNeil, and Pfizer for advisory activities involving the development of anticoagulant drugs. MP, CT, KZ, LRF, and SL are employees of Boehringer Ingelheim. GYHL has been a consultant for Bayer/Janssen, Astellas, Merck, Sanofi, Bristol-Myers Squibb (BMS)/Pfizer, Biotronik, Medtronic, Portola, Boehringer Ingelheim, Microlife, and Daiichi-Sankyo; and has been a speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Microlife, Roche, and Daiichi-Sankyo.

      Authorship: All authors had access to the data and played a role in writing this manuscript.

      Identification

      DOI: https://doi.org/10.1016/j.amjmed.2018.03.024

      Copyright

      © 2018 Elsevier Inc. All rights reserved.

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