Sex Differences in Patients Receiving Anticoagulant Therapy for Venous Thromboembolism

Abstract: In patients with venous thromboembolism (VTE), the outcome during the course of anticoagulant therapymay differ according to the patient’s sex.We used the RIETE (Registro Informatizado Enfermedad TromboEmbolica) database to compare the rate of VTE recurrences, major bleeding, andmortality due to these events according to sex. As of August 2013, 47,499 patients were enrolled in RIETE, of whom 24,280 (51%) were women. Women were older, more likely presented with pulmonary embolism (PE), and were more likely to have recent immobilization but less likely to have cancer than men. During the course of anticoagulation (mean duration: 253d), 659 patients developed recur-rent deep vein thrombosis (DVT), 576 recurrent PE, 1368 bled, and 4506 died. Compared with men, women had a lower rate of DVT recurrences (hazard ratio [HR]: 0.78; 95 % confidence interval [CI]: 0.67–0.91), a similar rate of PE recurrences (HR: 0.98; 95 % CI: 0.83–1.15), a higher rate of major bleeding (HR: 1.21; 95 % CI: 1.09–1.35), and higher mortality due to PE (HR: 1.24; 95 % CI: 1.04–1.47). On multivariable analysis, any influence of sex on the risk for recurrent DVT (HR: 0.88; 95 % CI: 0.75– 1.03), major bleeding (HR: 1.10; 95 % CI: 0.98–1.24), or fatal PE (HR: 1.01; 95 % CI: 0.84–1.22) was no longer statistically significant. In conclusion, women had fewer DVT recurrences and more bleeds than men during the course of anticoagulation. These differences were not due to sex, but very likely to other patient characteristics more common in female patients and differences in treatment choice. (Medicine 2014;93: 309–317) Abbreviations: CI = confidence intervals, DVT = deep vein thrombosis, HR = hazard ratio, LMWH = low-molecular-weight heparin, PE = pulmonary embolism, VKA = vitamin K antago-nists, VTE = venous thromboembolism