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

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 (VKA) use. We aimed to analyze gender-specific anticoagulant prescription patterns early following the introduction of non-VKA oral anticoagulants (NOACs) in a large, global registry on atrial fibrillation. Methods and Results: 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; women 45.5%) enrolled between 2011 and 2014. Globally, 79.7% women and 80.2% men were anticoagulated; the absolute between-gender difference in prevalence of anticoagulant use was −0.5% (95% CI, −1.8%, 0.8%). VKAs were prescribed to 32.8% and 31.9% (NOACs 46.8% and 48.3%) of women and men, respectively. 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 score=1; CHADS2 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 upon guideline-related differences in stroke risk stratification rather than on gender.