Background and purposes: Recent evidence suggests that women have a higher frequency of atrial fibrillation (AF) compared to men, and those women with AF have a higher associated risk for thromboembolic events compared to men with AF. The aim of this study was to evaluate the sex-differences in patients with acute stroke and AF, regarding anti-thrombotic therapy, risks of both recurrence and cerebral bleedings as well as functional outcome.
Methods: Data from the RAF study, a prospective, multicentre, international study that included patients with acute stroke and AF were analysed. Patients were followed-up for 90 days. Disability was measured with modified Rankin Score (3 to 6 = disabled or dead).
Results: Of the 1,029 patients enrolled, there were 561 women (54.5%) (p<0.001), and they were younger (p<0.001) compared to the enrolled men. In patients with known AF, women were less likely to receive oral anticoagulants before index stroke (p=0.026) as well, more women were less likely to receive anticoagulants after stroke (28.8% versus 21.6%, p=0.009). There was no sex difference regarding the time when the anticoagulant therapy was initiated between the two groups (6.4±11.7 days in men versus 6.5±12.4 days in women, p=0.902). Men presented with more severe strokes at onset than women (mean NIHSS 9.2±6.9 versus 8.1±7.5, p<0.001). Within 90 days, women had 46 (8.2%) recurrent ischemic events (stroke/TIA/systemic embolism) and 19 (3.4%) symptomatic cerebral bleedings compared to 30 (6.4%) and 18 (3.8%) respectively in men (p=0.28 and p=0.74). At 90 days 57.7% of the women were disabled or dead compared to 41.1% of the men (p<0.001). On multivariate analysis, this significance was not present.
Conclusions: This study reveals that women with AF were less likely to receive oral anticoagulants prior to stroke and following stroke as secondary prevention compared to men with AF. On admission, women had a less severe stroke compared to men. At 90 days, there were no differences in both recurrent ischemic event and bleeding between the sexes as well as function outcome.