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).

Autor: Antonenko K; Department of Neurology, Bogomolets National Medical University, Kyiv, Ukraine., Paciaroni M; Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy., Agnelli G; Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy., Falocci N; Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy., Becattini C; Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy., Marcheselli S; Neurologia d'urgenza e Stroke Unit, Istituto Clinico Humanitas, Rozzano, Milano, Italy., Rueckert C; Abteilung für Neurologie, Oberschwabenklinik gGmbH, Ravensburg, Germany., Pezzini A; Department of Clinical and Experimental Sciences, Neurology Unit, University 'Health and Wealth' of Brescia, Italy., Poli L; Department of Clinical and Experimental Sciences, Neurology Unit, University 'Health and Wealth' of Brescia, Italy., Padovani A; Department of Clinical and Experimental Sciences, Neurology Unit, University 'Health and Wealth' of Brescia, Italy., Csiba L; Stroke Unit, University of Debrecen, Hungary., Szabó L; Stroke Unit, University of Debrecen, Hungary., Sohn SI; Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea., Tassinari T; Stroke Unit-Department of Neurology, Santa Corona Hospital, Pietra Ligure (Savona), Italy., Abdul-Rahim AH; Medical School and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom., Michel P; Centre Cerebrovasculaire, Service de Neurologie, Department des Neurosciences Cliniques Centre Hopitalier Universitaire Vaudois, Lausanne, Switzerland., Cordier M; Centre Cerebrovasculaire, Service de Neurologie, Department des Neurosciences Cliniques Centre Hopitalier Universitaire Vaudois, Lausanne, Switzerland., Vanacker P; Department of Neurology, Born Bunge Institute, Antwerp University Hospital, Antwerp, Belgium., Remillard S; Centre Cerebrovasculaire, Service de Neurologie, Department des Neurosciences Cliniques Centre Hopitalier Universitaire Vaudois, Lausanne, Switzerland., Alberti A; Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy., Venti M; Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy., Acciarresi M; Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy., D'Amore C; Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy., Scoditti U; Stroke Unit, Neuroscience Department, University of Parma, Italy., Denti L; Stroke Unit, Dipartimento Geriatrico Riabilitativo, University of Parma, Italy., Orlandi G; Clinica Neurologica, Azienda Ospedaliero-Universitaria, Pisa, Italy., Chiti A; Clinica Neurologica, Azienda Ospedaliero-Universitaria, Pisa, Italy., Gialdini G; Clinica Neurologica, Azienda Ospedaliero-Universitaria, Pisa, Italy., Bovi P; SSO Stroke Unit, UO Neurologia, DAI di Neuroscienze, AOUI Verona, Italy., Carletti M; SSO Stroke Unit, UO Neurologia, DAI di Neuroscienze, AOUI Verona, Italy., Rigatelli A; SSO Stroke Unit, UO Neurologia, DAI di Neuroscienze, AOUI Verona, Italy., Putaala J; Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland., Tatlisumak T; Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.; Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden., Masotti L; Department of Internal Medicine, Cecina Hospital, Cecina, Livorno, Italy., Lorenzini G; Department of Internal Medicine, Cecina Hospital, Cecina, Livorno, Italy., Tassi R; Stroke Unit, AOU Senese, Siena, Italy., Guideri F; Stroke Unit, AOU Senese, Siena, Italy., Martini G; Stroke Unit, AOU Senese, Siena, Italy., Tsivgoulis G; Department of Neurology, Democritus University of Thrace, University Hospital of Alexandroupolis, Greece.; International Clinic Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.; Second Department of Neurology, 'Attikon' Hospital, University of Athens, School of Medicine, Athens, Greece., Vadikolias K; Department of Neurology, Democritus University of Thrace, University Hospital of Alexandroupolis, Greece., Papageorgiou SG; Second Department of Neurology, 'Attikon' Hospital, University of Athens, School of Medicine, Athens, Greece., Corea F; UO Gravi Cerebrolesioni, San Giovanni Battista Hospital, Foligno, Italy., Sette MD; Stroke Unit, Department of Neurology, Sant'Andrea Hospital, La Spezia, Italy., Ageno W; Department of Internal Medicine, Insubria University, Varese, Italy., Lodovici ML; Stroke Unit, Neurology, Insubria University, Varese, Italy., Bono G; Stroke Unit, Neurology, Insubria University, Varese, Italy., Baldi A; Stroke Unit, Ospedale di Portogruaro, Portogruaro, Venice, Italy., D'Anna S; Stroke Unit, Ospedale di Portogruaro, Portogruaro, Venice, Italy., Sacco S; Department of Neurology, University of L'Aquila, Italy., Carolei A; Department of Neurology, University of L'Aquila, Italy., Tiseo C; Department of Neurology, University of L'Aquila, Italy., Imberti D; Department of Internal Medicine, Ospedale Civile di Piacenza, Italy., Zabzuni D; Department of Internal Medicine, Ospedale Civile di Piacenza, Italy., Doronin B; Municipal Budgetary Healthcare Institution of Novosibirsk, City Clinical Hospital, Novosibirsk, Russia., Volodina V; Municipal Budgetary Healthcare Institution of Novosibirsk, City Clinical Hospital, Novosibirsk, Russia., Consoli D; Stroke Unit, Jazzolino Hospital, Vibo Valentia, Italy., Galati F; Stroke Unit, Jazzolino Hospital, Vibo Valentia, Italy., Pieroni A; Department of Neurology and Psychiatry, Sapienza University of Rome, Italy., Toni D; Department of Neurology and Psychiatry, Sapienza University of Rome, Italy., Monaco S; Stroke Unit, Ospedale Civico, Palermo., Baronello MM; Stroke Unit, Ospedale Civico, Palermo., Barlinn K; Department of Neurology, Dresden University Stroke Center, Dresden, Germany., Pallesen LP; Department of Neurology, Dresden University Stroke Center, Dresden, Germany., Kepplinger J; Department of Neurology, Dresden University Stroke Center, Dresden, Germany., Bodechtel U; Department of Neurology, Dresden University Stroke Center, Dresden, Germany., Gerber J; Department of Neurology, Dresden University Stroke Center, Dresden, Germany., Deleu D; Neurology, Hamad Medical Corporation, Doha, Qatar., Melikyan G; Neurology, Hamad Medical Corporation, Doha, Qatar., Ibrahim F; Neurology, Hamad Medical Corporation, Doha, Qatar., Akhtar N; Neurology, Hamad Medical Corporation, Doha, Qatar., Mosconi MG; Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy., Lees KR; Medical School and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom., Caso V; Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy.
Jazyk: angličtina
Zdroj: European stroke journal [Eur Stroke J] 2017 Mar; Vol. 2 (1), pp. 46-53. Date of Electronic Publication: 2016 Nov 15.
DOI: 10.1177/2396987316679577
Abstrakt: 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.
Databáze: MEDLINE
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