Sex-related differences in risk factors, type of treatment received and outcomes in patients with atrial fibrillation and acute stroke: Results from the RAF-study (Early Recurrence and Cerebral Bleeding in Patients with Acute Ischemic Stroke and Atrial Fibrillation)

Research output: Contribution to journal › Research article › Contributed › peer-review

Contributors

  • Kateryna Antonenko - , Bogomolets National Medical University (Author)
  • Maurizio Paciaroni - , University of Perugia (Author)
  • Giancarlo Agnelli - , University of Perugia (Author)
  • Nicola Falocci - , University of Perugia (Author)
  • Cecilia Becattini - , University of Perugia (Author)
  • Simona Marcheselli - , IRCCS Istituto Clinico Humanitas - Rozzano (Milano) (Author)
  • Christina Rueckert - , Oberschwabenklinik Ravensburg (Author)
  • Alessandro Pezzini - , University of Brescia (Author)
  • Loris Poli - , University of Brescia (Author)
  • Alessandro Padovani - , University of Brescia (Author)
  • Laszló Csiba - , University of Debrecen (Author)
  • Lilla Szabó - , University of Debrecen (Author)
  • Sung Il Sohn - , Keimyung University (Author)
  • Tiziana Tassinari - , Santa Corona Hospital (Author)
  • Azmil H. Abdul-Rahim - , University of Glasgow (Author)
  • Patrik Michel - , University of Lausanne (Author)
  • Maria Cordier - , University of Lausanne (Author)
  • Peter Vanacker - , University of Antwerp (Author)
  • Suzette Remillard - , University of Lausanne (Author)
  • Andrea Alberti - , University of Perugia (Author)
  • Michele Venti - , University of Perugia (Author)
  • Monica Acciarresi - , University of Perugia (Author)
  • Cataldo D’Amore - , University of Perugia (Author)
  • Umberto Scoditti - , University of Parma (Author)
  • Licia Denti - , University of Parma (Author)
  • Giovanni Orlandi - , University of Pisa (Author)
  • Alberto Chiti - , University of Pisa (Author)
  • Gino Gialdini - , University of Pisa (Author)
  • Paolo Bovi - , Ospedale Policlinico (Author)
  • Monica Carletti - , Ospedale Policlinico (Author)
  • Alberto Rigatelli - , Ospedale Policlinico (Author)
  • Jukka Putaala - , University of Helsinki (Author)
  • Turgut Tatlisumak - , University of Helsinki, University of Gothenburg (Author)
  • Luca Masotti - , Cecina Hospital (Author)
  • Gianni Lorenzini - , Cecina Hospital (Author)
  • Rossana Tassi - , Azienda Ospedaliera Universitaria Senese (Author)
  • Francesca Guideri - , Azienda Ospedaliera Universitaria Senese (Author)
  • Giuseppe Martini - , Azienda Ospedaliera Universitaria Senese (Author)
  • Georgios Tsivgoulis - , Democritus University of Thrace, Masaryk University, National and Kapodistrian University of Athens (Author)
  • Kostantinos Vadikolias - , Democritus University of Thrace (Author)
  • Sokratis G. Papageorgiou - , National and Kapodistrian University of Athens (Author)
  • Francesco Corea - , Azienda Sanitaria Ospedaliera Molinette San Giovanni Battista Di Torino (Author)
  • Massimo Del Sette - , Sant'Andrea Hospital (Author)
  • Walter Ageno - , University of Insubria (Author)
  • Maria Luisa De Lodovici - , University of Insubria (Author)
  • Giorgio Bono - , University of Insubria (Author)
  • Antonio Baldi - , Ospedale di Portogruaro (Author)
  • Sebastiano D’Anna - , Ospedale di Portogruaro (Author)
  • Simona Sacco - , University of L'Aquila (Author)
  • Antonio Carolei - , University of L'Aquila (Author)
  • Cindy Tiseo - , University of L'Aquila (Author)
  • Davide Imberti - , Civil Hospital of Piacenza (Author)
  • Dorjan Zabzuni - , Civil Hospital of Piacenza (Author)
  • Boris Doronin - , City Clinical Hospital Eleven (Author)
  • Vera Volodina - , City Clinical Hospital Eleven (Author)
  • Domenico Consoli - , Jazzolino Hospital (Author)
  • Franco Galati - , Jazzolino Hospital (Author)
  • Alessio Pieroni - , University of Rome La Sapienza (Author)
  • Danilo Toni - , University of Rome La Sapienza (Author)
  • Serena Monaco - , Azienda Sanitaria Ulss 6 Vicenza (Author)
  • Mario M. Baronello - , Azienda Sanitaria Ulss 6 Vicenza (Author)
  • Kristian Barlinn - , Department of Neurology (Author)
  • Lars Peder Pallesen - , Department of Neurology (Author)
  • Jessica Kepplinger - , TUD Dresden University of Technology (Author)
  • Ulf Bodechtel - , TUD Dresden University of Technology (Author)
  • Johannes Gerber - , Department of Neurology (Author)
  • Dirk Deleu - , Hamad Medical Corporation (Author)
  • Gayane Melikyan - , Hamad Medical Corporation (Author)
  • Faisal Ibrahim - , Hamad Medical Corporation (Author)
  • Naveed Akhtar - , Hamad Medical Corporation (Author)
  • Maria G. Mosconi - , University of Perugia (Author)
  • Kennedy R. Lees - , University of Glasgow (Author)
  • Valeria Caso - , University of Perugia (Author)

Abstract

Introduction: Atrial fibrillation is an independent risk factor of thromboembolism. Women with atrial fibrillation are at a higher overall risk for stroke compared to men with atrial fibrillation. The aim of this study was to evaluate for sex differences 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 and Atrial Fibrillation” (RAF-study), a prospective, multicenter, international study including only patients with acute stroke and atrial fibrillation. Patients were followed up for 90 days. Disability was measured by the modified Rankin Scale (0–2 favorable 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 to men. In patients with known atrial fibrillation, women were less likely to receive oral anticoagulants before index stroke (p = 0.026) and were less likely to receive anticoagulants after stroke (71.3% versus 78.4%, p = 0.01). There was no observed sex difference regarding the time of starting anticoagulant therapy between the two groups (6.4 ± 11.7 days for men versus 6.5 ± 12.4 days for women, p = 0.902). Men presented with more severe strokes at onset (mean NIHSS 9.2 ± 6.9 versus 8.1 ± 7.5, 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 (p = 0.28 and p = 0.74). 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 stroke compared to men with atrial fibrillation, and when stroke occurred, regardless of the fact that in our study women were younger and with less severe stroke, outcomes did not differ between the sexes.

Details

Original languageEnglish
Pages (from-to)46-53
Number of pages8
JournalEuropean stroke journal
Volume2
Issue number1
Publication statusPublished - 1 Mar 2017
Peer-reviewedYes

External IDs

PubMed 30886901
PubMed PMC6377059
Scopus 85060509330

Keywords

Keywords

  • anticoagulation therapy, atrial fibrillation, ischemic stroke, secondary prevention, Sex differences, stroke outcome