Woman’s Risk of Atrial Fibrillation: Higher Risk, Less Attention

Woman’s Risk of Atrial Fibrillation: Higher Risk, Less Attention

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Description: Atrial Fibrillation is the most common chronic cardiac arrhythmia, it is estimated that the U.S. prevalence is 2.5 million. Atrial fibrillation places a significant burden on the healthcare system; a hospital stay for atrial fibrillation is more frequent than for any other arrhythmia.

It is interconnected with other common cardio vascular problems. .

Author: Annabelle S. Volgman, MD (Fellow) | Visits: 2341 | Page Views: 2388
Domain:  Medicine Category: Therapy Subcategory: Cardiovacular 
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Short URL: https://www.wesrch.com/medical/pdfME1LYY89LPFJT

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Women and Atrial Fibrillation, Greater Risk, Less Attention
Annabelle S. Volgman, MD, FACC Associate Professor of Medicine Director, Heart Center for Women Rush University Medical Center Chicago, Illinois

Case study
65 yo successful OB/GYN who managed a hospital, nursing school in the Philippines PMH:
Hypertension DM Atrial fibrillation Normal LV function No history of TIAs or stroke

Case study (Cont.)
NU required a breast biopsy for a suspicious mammogram. What is the right way to deal with her anticoagulation?

Pilote, L. et al. CMAJ 2007;176:S1-S44

Copenhagen City Heart Study
The independent effect of AF on stroke rate was 4.6-fold greater in women than in men:
Hazard ratio in women 7.8 (95% CI, 5.8 to 14.3) Hazard ratio in men 1.7 (95% CI, 1.0 to 3.0)

The independent effect of AF on the cardiovascular mortality rate was 2.5-fold greater in women than in men:
Hazard ratio in women 4.4 (95% CI, 2.9 to 6.5) Hazard ratio in men 2.2 (95% CI, 1.6 to 3.1)

Friberg J et al. American Journal of Cardiology 2004; 94: 889-894

Pilote, L. et al. CMAJ 2007;176:S1-S44

Gender Differences in the Risk of Ischemic Stroke and Peripheral Embolism in Atrial Fibrillation The AnTicoagulation and Risk factors In Atrial fibrillation (ATRIA) Study

Fang,MC et al. Circulation. 2005;112:1687-1691

Analysis of 5 Antithrombotic Trials
Women > 75 years were 54% less likely to receive warfarin and twice as likely to receive aspirin Warfarin reduced stroke risk by 84% in women and 60% in men ASA resulted in significantly decreased stroke risk in men (44%) but not in women (23%)
Pilote L, CMAJ. 2007; 176(6):S1-44.

Physician and Patient Reluctance
CARAF demonstrated that women on warfarin were 3.35 times more likely to experience major bleeding. Nine of ten women who experienced major bleeds were < 75 years old. INRs at time of bleeding were elevated, but the levels were similar in men and women.
Humphries KH et al. Circulation. 2001; 103:2365-70

Re-LY Study and Dabigatran
Randomized Evaluation of Long-Term Anticoagulant Therapy (RE-LY)
Dabigatran given at blinded 110 and 150 mg twice a day vs non-blinded warfarin (n=18,113) High dose reduced the annualized risk of the primary end point, stroke/peripheral embolic events, by 34% (p