The Tasmanian Atrial Fibrillation Study (TAFS): Differences in Stroke Prevention According to Sex

Background: There are limited Australian data on sex differences in oral anticoagulant (OAC) prescribing in atrialfibrillation (AF) and ongoing debate regarding the optimal approach to stroke risk assessment and OAC prescribing infemale patients with AF. Objective: The purpose of this study was to investigate sex differences in the prescribing ofOACs in patients with AF stratified by stroke risk and in the rate of adverse outcomes. Methods: A retrospective analysisof patients admitted to the Royal Hobart Hospital (Tasmania, Australia) with nonvalvular AF between January 2011 andJuly 2015 was conducted. Rates of antithrombotic prescribing according to sex and stroke risk were assessed along with amultivariate analysis for predictors of OAC prescribing. Rates of thromboembolism, bleeding, and all-cause mortality wereassessed according to sex. Results: A total of 2090 patients were included (44.7% female). Women with a CHA2DS2-VA score ≥2 were less likely to receive an OAC compared with men (56.7% vs 62.2%, P = 0.023). Female sex was anindependent negative predictor of OAC prescribing (adjusted odds ratio = 0.83; 95% CI = 0.69-0.99; P = 0.041). Therewere no sex differences in the incidence rates of thromboembolism, bleeding, or all-cause mortality in patients newlycommenced on antithrombotic therapy. Conclusion and Relevance: Female patients with a high stroke risk were lesslikely to receive guideline-recommended treatment. This study provides new information on prescribing trends within theAustralian setting and highlights the opportunity to improve the management of female patients with AF and 1 or moreadditional stroke risk factors