Korean Circ J.  2022 Aug;52(8):593-603. 10.4070/kcj.2021.0399.

Association of Gender With Clinical Outcomes in a Contemporary Cohort of Patients With Atrial Fibrillation Receiving Oral Anticoagulants

  • 1Division of Cardiology, Department of Internal Medicine, Myongji Hospital, Goyang, Korea
  • 2Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 3Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
  • 4Department of Cardiology, School of Medicine, Ewha Womans University, Seoul, Korea
  • 5Department of Cardiology, Hanyang University Seoul Hospital, Seoul, Korea
  • 6Division of Cardiology, Eulji University Hospital, Daejeon, Korea
  • 7Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
  • 8Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
  • 9Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea
  • 10Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
  • 11Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea


Background and Objectives
In patients with atrial fibrillation (AF), females taking vitamin K antagonist are at higher risk of stroke or systemic embolism (SSE), bleeding and all-cause death than males. This study investigated the relationship between sex and adverse clinical events in a contemporary AF patient cohort taking anticoagulation.
This prospective multicenter AF registry study comprised 6,067 patients with AF (mean age, 70±9 years; men, 59%) with intermediate to high risk of stroke (CHA 2 DS 2-VAscore ≥1) and receiving oral anticoagulation therapy. Adverse clinical outcomes, including SSE, bleeding, death were evaluated in patients stratified by sex and anticoagulation patterns.
Women were older and used more direct oral anticoagulants (85% vs. 78%, p<0.001) than men. During a median (25 the and 75 the percentiles) follow-up of 30 (24, 38) months, the incidence rate and risk of SSE (0.7 in women vs. 0.7 in men per 100 person-years) and major bleeding (0.1 in women vs. 0.1 in men per 100 person-years) were not different between the sexes. However, women had a lower all-cause death rate (0.4 in women vs. 0.6 in men per 100 person-years, hazard ratio: 0.48, 95% confidence interval: 0.25–0.91, p=0.025) than men.
In contemporary anticoagulation for AF, SSE and major bleeding risks did not differ between sexes. However, women showed a lower risk of all-cause death rate than men, indicating that the use of oral anticoagulants for treating AF in females does not appear to be a risk factor for adverse clinical events.


Atrial fibrillation; Female; Anticoagulants


  • Figure 1 Cumulative incidence of stroke or systemic embolism (A), major bleeding (B), and all-cause death (C).

  • Figure 2 Forest plot representation of clinical factors including anticoagulation associated with the primary endpoint (stroke or systemic embolism).CI = confidence interval; DOAC = direct oral anticoagulant; HR = hazard ratio; HTN = hypertension; MI = myocardial infarction; TIA = transient ischemic attack; VKA = vitamin K antagonist.

Cited by  1 articles

A ‘Gender Paradox’ of Female as a Stroke Risk in Atrial Fibrillation: Do Women Live Longer Than Men?
Joo Hee Jeong, Jong-Il Choi
Korean Circ J. 2022;52(8):604-605.    doi: 10.4070/kcj.2022.0175.


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