Sex-specific associations of oral anticoagulant use and cardiovascular outcomes in patients with atrial fibrillation

Background--sex-specific effectiveness of rivaroxaban (riva),dabigatran (dabi),and warfarin in reducing myocardial infarction (mi),heart failure (hf),and all-cause mortality among patients with atrial fibrillation are not known. we assessed sex-specific associations of riva,dabi,or warfarin use with the risk of mi,hf,and all-cause mortality among patients with atrial fibrillation. methods and results--medicare beneficiaries (men: 65 734 [44.8%],women: 81 135 [55.2%]) with atrial fibrillation who initiated oral anticoagulants formed the study cohort. inpatient admissions for mi,hf,and all-cause mortality were compared between the 3 drugs separately for men and women using 3-way propensity-matched samples. in men,riva use was associated with a reduced risk of mi admissions compared with warfarin use (hazard ratio [95% confidence interval (ci): 0.59 [0.38-0.91]),with a trend towards reduced risk compared with dabi use (0.67 [0.44-1.01]). in women,there were no significant differences in the risk of mi admissions across all 3 anticoagulants. in both sexes,riva use and dabi use were associated with reduced risk of hf admissions (men: riva; 0.75 [0.63-0.89],dabi; 0.81 [0.69-0.96]) (women: riva; 0.64 [0.56-0.74],dabi; 0.73 [0.63-0.83]) and all-cause mortality (men: riva; 0.66 [0.53-0.81],dabi; 0.75 [0.61-0.93]) (women: riva; 0.76 [0.63-0.91],dabi; 0.77 [0.64-0.93]) compared with warfarin use. conclusions--riva use and dabi use when compared with warfarin use was associated with a reduced risk of hf admissions and all-cause mortality in both sexes. however,reduced risk of mi admissions noted with riva use appears to be limited to men. © 2017 the authors and medtronic.