Related Experiment Video
Updated: Aug 8, 2025
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Sex Differences in Oral Anticoagulation Therapy in Patients Hospitalized With Atrial Fibrillation: A Nationwide
Kuan Ken Lee1, Dimitrios Doudesis1,2, Rong Bing1
1BHF Centre for Cardiovascular Science University of Edinburgh Edinburgh United Kingdom.
Insights
Women with atrial fibrillation (AF) were less likely to receive vitamin K antagonist treatment compared to men. However, the increased use of factor Xa inhibitors has reduced these gender disparities in oral anticoagulation therapy.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Significant disparities exist in the treatment and outcomes for women and men with atrial fibrillation (AF).
- The impact of direct oral anticoagulants (DOACs) on reducing these gender-based treatment disparities remains unclear.
- Understanding treatment patterns is crucial for equitable AF management.
Purpose of the Study:
- To investigate whether the introduction of DOACs has narrowed the treatment gap between women and men with nonvalvular AF.
- To analyze trends in oral anticoagulation therapy prescribing for nonvalvular AF in Scotland.
- To identify factors associated with the prescription of vitamin K antagonists (VKAs) versus DOACs.
Main Methods:
- A retrospective cohort study included all patients hospitalized with nonvalvular AF in Scotland from 2010 to 2019.
- Community drug dispensing data were utilized to ascertain oral anticoagulation therapy and comorbidity status.
- Logistic regression modeling was employed to assess patient factors linked to VKA and DOAC treatment.
Main Results:
- A total of 172,989 patients with nonvalvular AF were analyzed; 48% were women.
- By 2019, factor Xa inhibitors constituted 83.6% of prescribed oral anticoagulants, with VKA use declining to 15.9%.
- Women were less likely than men to receive any oral anticoagulation (aOR, 0.68). This disparity was primarily with VKAs (aOR, 0.68), while factor Xa inhibitor use showed less disparity (aOR, 0.92).
Conclusions:
- Women diagnosed with nonvalvular AF were prescribed vitamin K antagonists less frequently than men.
- The widespread adoption of factor Xa inhibitors in Scotland for nonvalvular AF is associated with diminished treatment disparities between genders.
- Current treatment trends suggest improved equity in anticoagulation management for women with AF.
Abstract:
Background Important disparities in the treatment and outcomes of women and men with atrial fibrillation (AF) are well recognized. Whether introduction of direct oral anticoagulants has reduced disparities in treatment is uncertain. Methods and Results All patients who had an incident hospitalization from 2010 to 2019 with nonvalvular AF in Scotland were included in the present cohort study. Community drug dispensing data were used to determine prescribed oral anticoagulation therapy and comorbidity status. Logistic regression modeling was used to evaluate patient factors associated with treatment with vitamin K antagonists and direct oral anticoagulants. A total of 172 989 patients (48% women [82 833 of 172 989]) had an incident hospitalization with nonvalvular AF in Scotland between 2010 and 2019. By 2019, factor Xa inhibitors accounted for 83.6% of all oral anticoagulants prescribed, while treatment with vitamin K antagonists and direct thrombin inhibitors declined to 15.9% and 0.6%, respectively. Women were less likely to be prescribed any oral anticoagulation therapy compared with men (adjusted odds ratio [aOR], 0.68 [95% CI, 0.67-0.70]). This disparity was mainly attributed to vitamin K antagonists (aOR, 0.68 [95% CI, 0.66-0.70]), while there was less disparity in the use of factor Xa inhibitors between women and men (aOR, 0.92 [95% CI, 0.90-0.95]). Conclusions Women with nonvalvular AF were significantly less likely to be prescribed vitamin K antagonists compared with men. Most patients admitted to the hospital in Scotland with incident nonvalvular AF are now treated with factor Xa inhibitors and this is associated with fewer treatment disparities between women and men.
Related Concept Videos
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:29Venous Thrombosis III: Interprofessional Care
01:30Venous Thrombosis IV: Nursing Management
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:22Antiarrhythmic Drugs: Class I Agents as Sodium Channel Blockers
Class 1A Antiarrhythmic Drugs: These drugs work by moderately blocking sodium channels,...