Warfarin decreases risk of stroke for patients with atrial fibrillation (AF) dependent on percent time in the therapeutic range (TTR) with an international normalized ratio (INR) of 2 to 3. We hypothesized that gender differences in ischemic stroke risk are related to TTR. From the AFFIRM database of 4,060 patients with AF, we determined the incidence of ischemic stroke by gender. We evaluated the INR at time of ischemic stroke and calculated TTR. We determined the relation between gender and ischemic stroke by TTR. Women had CHADS(2) Scores (3.7 ± 1.3 vs 2.5 ± 1.3, p <0.0001) and more ischemic strokes than men (5% vs 3%, odds ratio 1.6, 95% confidence interval 1.19 to 2.26, p = 0.002). Mean INR near time of ischemic stroke was 2 for women and men; median values were subtherapeutic (1.7 and 1.8, respectively). Women spent more time outside the therapeutic range (40 ± 0.7% vs 37 ± 0.5%, p = 0.0001), with more time below the therapeutic range (29 ± 0.7% vs 26 ± 0.5%, p = 0.0002). A higher TTR protected against ischemic stroke for women but not for men. Women who had a comparably high TTR (≥66%) still had more ischemic strokes (p = 0.009). A fitted Cox proportional hazard regression model showed that gender, TTR <46% versus >80%, age, and previous stroke were significantly related to stroke incidence. In conclusion, women in AFFIRM were at greater risk of ischemic stroke than men, in part related to differences in TTR. Women with AF may benefit from more aggressive or novel anticoagulation to decrease their risk of stroke.

译文

华法林可降低房颤 (AF) 患者的中风风险,这取决于治疗范围 (TTR) 内的时间百分比,国际标准化比率 (INR) 为2至3。我们假设缺血性卒中风险的性别差异与TTR有关。从4,060例AF患者的AFFIRM数据库中,我们确定了按性别划分的缺血性中风的发生率。我们评估缺血性卒中时的INR并计算TTR。我们通过TTR确定了性别与缺血性中风之间的关系。女性的CHADS(2) 得分 (3.7 ± 1.3 vs 2.5 ± 1.3,p <0.0001) 和较男性的缺血性卒中 (5% vs 3%,优势比1.6,95% 置信区间1.19至2.26,p = 0.002)。女性和男性的平均INR接近缺血性卒中时间为2; 中值为亚治疗 (分别为1.7和1.8)。女性在治疗范围外花费的时间更多 (40 ± 0.7% vs 37 ± 0.5%,p = 0.0001),而在治疗范围以下的时间更多 (29 ± 0.7% vs 26 ± 0.5%,p = 0.0002)。较高的TTR可防止女性缺血性中风,但男性则不能。TTR相对较高 (≥ 66%) 的女性仍有更多的缺血性中风 (p = 0.009)。拟合的Cox比例风险回归模型显示,性别、TTR <46% vs> 80% 、年龄和既往卒中与卒中发生率显著相关。总之,AFFIRM中的女性比男性患缺血性中风的风险更高,部分原因与TTR的差异有关。房颤妇女可能受益于更积极的或新的抗凝治疗,以降低中风风险。

+1
+2
100研值 100研值 ¥99课程
检索文献一次
下载文献一次

去下载>

成功解锁2个技能,为你点赞

《SCI写作十大必备语法》
解决你的SCI语法难题!

技能熟练度+1

视频课《玩转文献检索》
让你成为检索达人!

恭喜完成新手挑战

手机微信扫一扫,添加好友领取

免费领《Endnote文献管理工具+教程》

微信扫码, 免费领取

手机登录

获取验证码
登录