학술논문
Sex-related differences in risk factors,type of treatment received and outcomesin patients with atrial fibrillation and acutestroke: Results from the RAF-study(Early Recurrence and Cerebral Bleedingin Patients with Acute IschemicStroke and Atrial Fibrillation)
Document Type
Author
Antonenko, Kateryna; Paciaroni, Maurizio; Agnelli, Giancarlo; Falocci, Nicola; Becattini, Cecilia; Marcheselli, Simona; Rueckert, Christina; Pezzini, Alessandro; Poli, Loris; Padovani, Alessandro; Csiba, Laszlo; Szabó, Lilla; Sohn, Sung-Il; Tassinari, Tiziana; Abdul-Rahim, Azmil H; Michel, Patrik; Cordier, Maria; Vanacker, Peter; Remillard, Suzette; Alberti, Andrea; Venti, Michele; Acciarresi, Monica; D’Amore, Cataldo; Scoditti, Umberto; Denti, Licia; Orlandi, Giovanni; Chiti, Alberto; Gialdini, Gino; Bovi, Paolo; Carletti, Monica; Rigatelli, Alberto; Putaala, Jukka; Tatlisumak, Turgut; Masotti, Luca; Lorenzini, Gianni; Tassi, Rossana; Guideri, Francesca; Martini, Giuseppe; Tsivgoulis, Georgios; Vadikolias, Konstantinos; Papageorgiou, Sokratis G; Corea, Francesco; Del Sette, Massimo; Ageno, Walter; De Lodovici, Maria Luisa; Bono, Giorgio; Baldi, Antonio; D’Anna, Sebastiano; Sacco, Simona; Carolei, Antonio; Tiseo, Cindy; Imberti, Davide; Zabzuni, Dorjan; Doronin, Boris; Volodina, Vera; Consoli, Domenico; Galati, Franco; Pieroni, Alessio; Toni, Danilo; Monaco, Serena; Baronello, Mario M; Barlinn, Kristian; Pallesen, Lars-Peder; Kepplinger, Jessica; Bodechtel, Ulf; Gerber, Johannes; Deleu, Dirk; Melikyan, Gayane; Ibrahim, Faisal; Akhtar, Naveed; Mosconi, Maria G; Lees, Kennedy R; Caso, Valeria
Source
European Stroke Journal. 2(1):46-53
Subject
Language
English
Abstract
Introduction: Atrial fibrillation is an independent risk factor of thromboembolism. Women with atrial fibrillation are ata higher overall risk for stroke compared to men with atrial fibrillation. The aim of this study was to evaluate for sexdifferences in patients with acute stroke and atrial fibrillation, regarding risk factors, treatments received and outcomes.Methods: Data were analyzed from the ‘‘Recurrence and Cerebral Bleeding in Patients with Acute Ischemic Stroke andAtrial Fibrillation’’ (RAF-study), a prospective, multicenter, international study including only patients with acute strokeand atrial fibrillation. Patients were followed up for 90 days. Disability was measured by the modified Rankin Scale (0–2favorable outcome, 3–6 unfavorable outcome).Results: Of the 1029 patients enrolled, 561 were women (54.5%) (p<0.001) and younger (p<0.001) compared tomen. In patients with known atrial fibrillation, women were less likely to receive oral anticoagulants before index stroke(p¼0.026) and were less likely to receive anticoagulants after stroke (71.3% versus 78.4%, p¼0.01). There was noobserved sex difference regarding the time of starting anticoagulant therapy between the two groups (6.411.7 days formen versus 6.512.4 days for women, p¼0.902). Men presented with more severe strokes at onset (mean NIHSS9.26.9 versus 8.17.5, p<0.001). Within 90 days, 46 (8.2%) recurrent ischemic events (stroke/TIA/systemic embolism)and 19 (3.4%) symptomatic cerebral bleedings were found in women compared to 30 (6.4%) and 18 (3.8%) in men(p¼0.28 and p¼0.74). At 90 days, 57.7% of women were disabled or deceased, compared to 41.1% of the men(p<0.001). Multivariate analysis did not confirm this significance.Conclusions: Women with atrial fibrillation were less likely to receive oral anticoagulants prior to and after strokecompared to men with atrial fibrillation, and when stroke occurred, regardless of the fact that in our study women wereyounger and with less severe stroke, outcomes did not differ between the sexes.