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)

Kateryna Antonenko¹, Maurizio Paciaroni², Giancarlo Agnelli², Nicola Falocci², Cecilia Becattini², Simona Marcheselli³, Christina Rueckert⁴, Alessandro Pezzini⁵, Loris Poli⁵, Alessandro Padovani⁵, Laszló Csiba⁶, Lilla Szabó⁶, Sung-Il Sohn⁷, Tiziana Tassinari⁸, Azmil H Abdul-Rahim⁹, Patrik Michel¹⁰, Maria Cordier¹⁰, Peter Vanacker¹¹, Suzette Remillard¹⁰, Andrea Alberti², Michele Venti², Monica Acciarresi², Cataldo D'Amore², Umberto Scoditti¹², Licia Denti¹³, Giovanni Orlandi¹⁴, Alberto Chiti¹⁴, Gino Gialdini¹⁴, Paolo Bovi¹⁵, Monica Carletti¹⁵, Alberto Rigatelli¹⁵, Jukka Putaala¹⁶, Turgut Tatlisumak^{16

17

18}, Luca Masotti¹⁹, Gianni Lorenzini¹⁹, Rossana Tassi²⁰, Francesca Guideri²⁰, Giuseppe Martini²⁰, Georgios Tsivgoulis^{21

22

23}, Kostantinos Vadikolias²¹, Sokratis G Papageorgiou²³, Francesco Corea²⁴, Massimo Del Sette²⁵, Walter Ageno²⁶, Maria Luisa De Lodovici²⁷, Giorgio Bono²⁷, Antonio Baldi²⁸, Sebastiano D'Anna²⁸, Simona Sacco²⁹, Antonio Carolei²⁹, Cindy Tiseo²⁹, Davide Imberti³⁰, Dorjan Zabzuni³⁰, Boris Doronin³¹, Vera Volodina³¹, Domenico Consoli³², Franco Galati³², Alessio Pieroni³³, Danilo Toni³³, Serena Monaco³⁴, Mario M Baronello³⁴, Kristian Barlinn³⁵, Lars-Peder Pallesen³⁵, Jessica Kepplinger³⁵, Ulf Bodechtel³⁵, Johannes Gerber³⁵, Dirk Deleu³⁶, Gayane Melikyan³⁶, Faisal Ibrahim³⁶, Naveed Akhtar³⁶, Maria G Mosconi², Kennedy R Lees⁹, Valeria Caso²

Affiliations

¹ Department of Neurology, Bogomolets National Medical University, Kyiv, Ukraine.
² Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy.
³ Neurologia d'urgenza e Stroke Unit, Istituto Clinico Humanitas, Rozzano, Milano, Italy.
⁴ Abteilung für Neurologie, Oberschwabenklinik gGmbH, Ravensburg, Germany.
⁵ Department of Clinical and Experimental Sciences, Neurology Unit, University "Health and Wealth" of Brescia, Italy.
⁶ Stroke Unit, University of Debrecen, Hungary.
⁷ Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea.
⁸ Stroke Unit-Department of Neurology, Santa Corona Hospital, Pietra Ligure (Savona), Italy.
⁹ Medical School and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
¹⁰ Centre Cerebrovasculaire, Service de Neurologie, Department des Neurosciences Cliniques Centre Hopitalier Universitaire Vaudois, Lausanne, Switzerland.
¹¹ Department of Neurology, Born Bunge Institute, Antwerp University Hospital, Antwerp, Belgium.
¹² Stroke Unit, Neuroscience Department, University of Parma, Italy.
¹³ Stroke Unit, Dipartimento Geriatrico Riabilitativo, University of Parma, Italy.
¹⁴ Clinica Neurologica, Azienda Ospedaliero-Universitaria, Pisa, Italy.
¹⁵ SSO Stroke Unit, UO Neurologia, DAI di Neuroscienze, AOUI Verona, Italy.
¹⁶ Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.
¹⁷ Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
¹⁸ Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
¹⁹ Department of Internal Medicine, Cecina Hospital, Cecina, Livorno, Italy.
²⁰ Stroke Unit, AOU Senese, Siena, Italy.
²¹ Department of Neurology, Democritus University of Thrace, University Hospital of Alexandroupolis, Greece.
²² International Clinic Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.
²³ Second Department of Neurology, "Attikon" Hospital, University of Athens, School of Medicine, Athens, Greece.
²⁴ UO Gravi Cerebrolesioni, San Giovanni Battista Hospital, Foligno, Italy.
²⁵ Stroke Unit, Department of Neurology, Sant'Andrea Hospital, La Spezia, Italy.
²⁶ Department of Internal Medicine, Insubria University, Varese, Italy.
²⁷ Stroke Unit, Neurology, Insubria University, Varese, Italy.
²⁸ Stroke Unit, Ospedale di Portogruaro, Portogruaro, Venice, Italy.
²⁹ Department of Neurology, University of L'Aquila, Italy.
³⁰ Department of Internal Medicine, Ospedale Civile di Piacenza, Italy.
³¹ Municipal Budgetary Healthcare Institution of Novosibirsk, City Clinical Hospital, Novosibirsk, Russia.
³² Stroke Unit, Jazzolino Hospital, Vibo Valentia, Italy.
³³ Department of Neurology and Psychiatry, Sapienza University of Rome, Italy.
³⁴ Stroke Unit, Ospedale Civico, Palermo.
³⁵ Department of Neurology, Dresden University Stroke Center, Dresden, Germany.
³⁶ Neurology, Hamad Medical Corporation, Doha, Qatar.

PMID: 30886901
PMCID: PMC6377059
DOI: 10.1177/2396987316679577

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)

Kateryna Antonenko et al. Eur Stroke J. 2017 Mar.

. 2017 Mar;2(1):46-53.

doi: 10.1177/2396987316679577. Epub 2016 Nov 15.

Authors

Affiliations

¹ Department of Neurology, Bogomolets National Medical University, Kyiv, Ukraine.
² Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy.
³ Neurologia d'urgenza e Stroke Unit, Istituto Clinico Humanitas, Rozzano, Milano, Italy.
⁴ Abteilung für Neurologie, Oberschwabenklinik gGmbH, Ravensburg, Germany.
⁵ Department of Clinical and Experimental Sciences, Neurology Unit, University "Health and Wealth" of Brescia, Italy.
⁶ Stroke Unit, University of Debrecen, Hungary.
⁷ Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea.
⁸ Stroke Unit-Department of Neurology, Santa Corona Hospital, Pietra Ligure (Savona), Italy.
⁹ Medical School and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
¹⁰ Centre Cerebrovasculaire, Service de Neurologie, Department des Neurosciences Cliniques Centre Hopitalier Universitaire Vaudois, Lausanne, Switzerland.
¹¹ Department of Neurology, Born Bunge Institute, Antwerp University Hospital, Antwerp, Belgium.
¹² Stroke Unit, Neuroscience Department, University of Parma, Italy.
¹³ Stroke Unit, Dipartimento Geriatrico Riabilitativo, University of Parma, Italy.
¹⁴ Clinica Neurologica, Azienda Ospedaliero-Universitaria, Pisa, Italy.
¹⁵ SSO Stroke Unit, UO Neurologia, DAI di Neuroscienze, AOUI Verona, Italy.
¹⁶ Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.
¹⁷ Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
¹⁸ Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
¹⁹ Department of Internal Medicine, Cecina Hospital, Cecina, Livorno, Italy.
²⁰ Stroke Unit, AOU Senese, Siena, Italy.
²¹ Department of Neurology, Democritus University of Thrace, University Hospital of Alexandroupolis, Greece.
²² International Clinic Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.
²³ Second Department of Neurology, "Attikon" Hospital, University of Athens, School of Medicine, Athens, Greece.
²⁴ UO Gravi Cerebrolesioni, San Giovanni Battista Hospital, Foligno, Italy.
²⁵ Stroke Unit, Department of Neurology, Sant'Andrea Hospital, La Spezia, Italy.
²⁶ Department of Internal Medicine, Insubria University, Varese, Italy.
²⁷ Stroke Unit, Neurology, Insubria University, Varese, Italy.
²⁸ Stroke Unit, Ospedale di Portogruaro, Portogruaro, Venice, Italy.
²⁹ Department of Neurology, University of L'Aquila, Italy.
³⁰ Department of Internal Medicine, Ospedale Civile di Piacenza, Italy.
³¹ Municipal Budgetary Healthcare Institution of Novosibirsk, City Clinical Hospital, Novosibirsk, Russia.
³² Stroke Unit, Jazzolino Hospital, Vibo Valentia, Italy.
³³ Department of Neurology and Psychiatry, Sapienza University of Rome, Italy.
³⁴ Stroke Unit, Ospedale Civico, Palermo.
³⁵ Department of Neurology, Dresden University Stroke Center, Dresden, Germany.
³⁶ Neurology, Hamad Medical Corporation, Doha, Qatar.

PMID: 30886901
PMCID: PMC6377059
DOI: 10.1177/2396987316679577

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.

Keywords: Sex differences; anticoagulation therapy; atrial fibrillation; ischemic stroke; secondary prevention; stroke outcome.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: M Paciaroni has received honoraria as a member of the speaker bureaus of Sanofi-Aventis, Boehringer Ingelheim, Bayer and Pfizer. G Agnelli has received honoraria as a member of the speaker bureaus of Boehringer Ingelheim and Bayer. C Becattini has received honoraria as a member of the speaker bureaus of Bristol Meyer Squibb and Bayer P Michel has received a Research Grant from the Swiss National Science Foundation and Swiss Heart Foundation; he has also received speaker fees from Bayer, Boehringer Ingelheim, Covidien, St. Jude Medical as well as received honoraria for an advisory relationship from Pierre-Fabre, Bayer, Bristol Meyer Squibb, Amgen, and Boehringer Ingelheim. J Putaala has received honoraria for lectures related to atrial fibrillation and anticoagulants for Orion Pharma, Bristol Meyer Squibb, Pfizer, Bayer, and Boehringer Ingelheim. T Tatlisumak received honoraria as consultant or advisory relationship by Lundbeck and Boehringer Ingelheim. G Tsivgoulis had research support by European Regional Development Fund, Project St. Anne's University Hospital, Brno, International Clinical Research Center (FNUSA-ICRC) (No. CZ.1.05/1.1.00/02.0123). D Toni has received honoraria as a member of speaker bureaus and as advisory board member for Boehringer Ingelheim and Bayer. The other authors report no conflicts.

References

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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)

Affiliations

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)

Authors

Affiliations

Abstract

Conflict of interest statement

References

Grants and funding

LinkOut - more resources

Full Text Sources

Research Materials

Miscellaneous