DOACs Associated With Reduced Risk of Intracranial Hemorrhage, All-Cause Mortality in Women

Direct oral anticoagulants (DOACs) are associated with a lower risk of intracranial hemorrhage and all-cause mortality among women with atrial fibrillation (AFib), according to a study in the Journal of the American College of Cardiology.

Researchers led by Sharon Law, MPharm, conducted a population-based cohort study to compare the effectiveness and safety of DOACs vs. warfarin in women and men with AFib, stratifying for anticoagulation control. The study’s primary outcome was the composite of ischemic stroke and systemic embolism. Secondary outcomes included intracranial hemorrhage, gastrointestinal bleeding and all-cause mortality. 

Using data from Hong Kong’s Clinical Data Analysis and Reporting system, the researchers identified 15,292 participants, 48 percent of whom were women, who had a new AFib diagnosis between 2010 and 2015. Researchers conducted propensity scoring separately for men and women and matched DOAC users to warfarin users at a 1:1 ratio. Among men, 152 (6.11 percent) of warfarin users and 140 (5.63 percent) of DOAC users experienced ischemic stroke and systemic embolism. In comparison, among women, ischemic stroke and systemic embolism occurred in 191 (7.9 percent) of warfarin users and 153 (6.33 percent) of DOAC users. Use of DOACs was associated with a reduced risk of intracranial hemorrhage and all-cause mortality when compared with warfarin among women only. DOAC use was associated with a lower risk of gastrointestinal bleeding for both men and women.

According to the authors, additional research is necessary to “evaluate the sex differences in the clinical outcomes of DOACs vs. warfarin based on the different mechanism of action of the drugs.”

In an accompanying editorial commentary, Giulia Renda, MD, PhD, et al., the study’s results point to the “existence of gender difference in thrombotic and hemorrhagic risk and in the response to anticoagulants” and could “imply different efficacy and safety profile of the DOACs in patients with atrial fibrillation according to gender.”

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Anticoagulation Management and Atrial Fibrillation, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Warfarin, Anticoagulants, Atrial Fibrillation, Stroke, Brain Ischemia, Embolism, Intracranial Hemorrhages, Blood Coagulation, Thrombosis


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