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Inicio Medicina Clínica (English Edition) Gender differences in antithrombotic treatment in patients with atrial fibrillat...
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Vol. 159. Issue 4.
Pages 177-182 (August 2022)
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Vol. 159. Issue 4.
Pages 177-182 (August 2022)
Original article
Gender differences in antithrombotic treatment in patients with atrial fibrillation from Spain versus the rest of Western Europe. GLORIA-AF Program
Diferencias de sexo en el tratamiento antitrombótico en pacientes con fibrilación auricular en España y el resto de Europa Occidental. Registro GLORIA-AF
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José L. López-Sendóna,
Corresponding author
jlopezsendon@gmail.com

Corresponding author.
, David Alonso-Rodríguezb, Gonzalo Barón-Esquiviasc, Juan Cosin-Salesd, Francisco Maríne, Jordi Galera-Llorcaf, Natalia Jiménezg, Sabrina Marlerh, Menno V. Huismani,1, Gregory Y.H. Lipj,1, on behalf of the Spanish GLORIA-AF investigators
a Hospital Universitario La Paz, IDIPAZ, CIBER-CV, Paseo de la Castellana 261, 28046 Madrid, Spain
b Complejo Asistencial Universitario, C/Altos de Nava s/n, León, Spain
c Clínica ABP Salud, Sevilla, Av. Manuel Siurot, 19 bajo, 41013, Sevilla, Spain
d Hospital Arnau de Vilanova, Carrer de Sant Clement, 12, 46015 Valencia, Spain
e Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, CIBERCV, Ctra. Madrid-Cartagena, s/n, Murcia, Spain
f TFS Health Science, Passeig de Gracia 11, 08007 Barcelona, Spain
g Boehringer Ingelheim Spain, Carrer de Prat de la Riba, 50, 08174 Sant Cugat del Vallès, Barcelona, Spain
h Boehringer Ingelheim Pharmaceuticals Inc, 900 Ridgebury Rd, Ridgefield, CT 06877, USA
i Leiden University Medical Centre, Leiden, Albinusdreef 2, 2333 ZA Leiden, Netherlands
j University of Liverpool and Liverpool Heart & Chest, Thomas Dr, Liverpool L14 3PE, UK
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Abstract
Background and objective

Thromboembolic risk is higher in women than men with non-valvular atrial fibrillation (NVAF). Published data indicate variability in antithrombotic use by gender and region. We analyzed gender-specific antithrombotic treatment patterns in Spain and rest of Western Europe (rWE) in patients with NVAF.

Methods

GLORIA-AF (Phase III) is a global, prospective, observational study which enrolled newly diagnosed NVAF patients with CHA2DS2-VAScs1 (2014–2016). Analyses were performed comparing antithrombotic treatments by gender in Spain and rWE.

Results

This analysis included 1163 and 7972 patients from Spain and rWE, respectively. Stroke risk was higher in women than men in both Spain and rWE. While in rWE, bleeding risk and antithrombotic treatment pattern were similar between genders, in Spain bleeding risk in women was lower and more females compared to men received OACs (95.0% versus 92.4%, d=−0.1078, respectively). Fewer Spanish patients received direct oral anticoagulants (DOACs) (women 32.1%, men 25.3%) than vitamin-K-antagonists (VKAs) (women 63.0%, men 67.1%) vs. rWE patients. In Spain women received more DOACs compared to men (56.0% versus 44.0%).

Conclusions

OAC rates were higher in Spain as compared to rWE. More women received OACs in Spain, while in rWE no difference by gender was observed. DOACs in rWE are the most prescribed OAC while in Spain, due to prescription barriers, its use remains low for both genders and VKAs are preferred. Spanish women received more DOACs compared to men. (NCT01468701).

Keywords:
Atrial fibrillation
Gender
GLORIA-AF
Direct oral anticoagulants
Antivitamin K antagonists
Resumen
Antecedentes y objetivo

El riesgo tromboembólico es mayor en mujeres que en varones con fibrilación auricular no valvular (FANV). Existen diferencias en el uso de anticoagulantes (ACO) según sexo y zona geográfica. Se estudiaron los patrones de anticoagulación por sexo en España y el resto de Europa Occidental (rEO) en pacientes con FANV.

Métodos

GLORIA-AF es un estudio observacional prospectivo (fase III) que incluyó a pacientes con diagnóstico reciente de FANV y CHA2DS2-VASc>1 (2014-2016). Se analizó la prescripción de anticoagulantes por sexo en España y el rEO.

Resultados

Se incluyó a 1.163 pacientes de España y 7.972 del rEO. El riesgo de ictus fue superior en mujeres tanto en España como en el rEO. El riesgo de hemorragia y el tratamiento antitrombótico fueron similares en ambos sexos en el rEO; en España, el riesgo de hemorragia fue menor en mujeres y estas recibieron más ACO que los varones (95,0% vs. 92,4%, d=–0,1078). En España, menos pacientes recibieron ACO directos (ACOD) (mujeres 32,1%, varones 25,3%) vs. antagonistas de la vitamina K (AVK) (mujeres 63,0%, varones 67,1%), y las mujeres recibieron más ACOD que los varones (56,0% vs. 44,0%).

Conclusiones

En España se emplearon más ACO que en el rEO y más mujeres fueron tratadas con ACO, mientras que en el rEO no hubo diferencias por sexo. En el rEO, los ACOD se emplearon más. En España, los ACOD se emplean menos por restricciones de prescripción y se emplean más los AVK. Las mujeres españolas reciben más ACOD que los varones. (NCT01468701).

Palabras clave:
Fibrilación auricular
Sexo
GLORIA-AF
Anticoagulantes directos
Antagonistas de la vitamina K

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