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)

Kateryna Antonenko, Maurizio Paciaroni, Giancarlo Agnelli, Nicola Falocci, Cecilia Becattini, Simona Marcheselli, Christina Rueckert, Alessandro Pezzini, Loris Poli, Alessandro Padovani, Laszló Csiba, Lilla Szabó, Sung Il Sohn, Tiziana Tassinari, Azmil H. Abdul-Rahim, Patrik Michel, Maria Cordier, Peter Vanacker, Suzette Remillard, Andrea Alberti & 53 others Michele Venti, Monica Acciarresi, Cataldo D’Amore, Umberto Scoditti, Licia Denti, Giovanni Orlandi, Alberto Chiti, Gino Gialdini, Paolo Bovi, Monica Carletti, Alberto Rigatelli, Jukka Putaala, Turgut Tatlisumak, Luca Masotti, Gianni Lorenzini, Rossana Tassi, Francesca Guideri, Giuseppe Martini, Georgios Tsivgoulis, Kostantinos Vadikolias, Sokratis G. Papageorgiou, Francesco Corea, Massimo Del Sette, Walter Ageno, Maria Luisa De Lodovici, Giorgio Bono, Antonio Baldi, Sebastiano D’Anna, Simona Sacco, Antonio Carolei, Cindy Tiseo, Davide Imberti, Dorjan Zabzuni, Boris Doronin, Vera Volodina, Domenico Consoli, Franco Galati, Alessio Pieroni, Danilo Toni, Serena Monaco, Mario M. Baronello, Kristian Barlinn, Lars Peder Pallesen, Jessica Kepplinger, Ulf Bodechtel, Johannes Gerber, Dirk Deleu, Gayane Melikyan, Faisal Ibrahim, Naveed Akhtar, Maria G. Mosconi, Kennedy R. Lees, Valeria Caso

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)46-53
Number of pages8
JournalEuropean Stroke Journal
Volume2
Issue number1
DOIs
StatePublished - Mar 1 2017

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Sex Characteristics
Atrial Fibrillation
Stroke
Hemorrhage
Recurrence
Anticoagulants
Thromboembolism
Embolism
Multicenter Studies
Multivariate Analysis
Prospective Studies

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

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). / Antonenko, Kateryna; Paciaroni, Maurizio; Agnelli, Giancarlo; Falocci, Nicola; Becattini, Cecilia; Marcheselli, Simona; Rueckert, Christina; Pezzini, Alessandro; Poli, Loris; Padovani, Alessandro; Csiba, Laszló; Szabó, Lilla; Sohn, Sung Il; Tassinari, Tiziana; Abdul-Rahim, Azmil H.; Michel, Patrik; Cordier, Maria; Vanacker, Peter; Remillard, Suzette; Alberti, Andrea; Venti, Michele; Acciarresi, Monica; D’Amore, Cataldo; Scoditti, Umberto; Denti, Licia; Orlandi, Giovanni; Chiti, Alberto; Gialdini, Gino; Bovi, Paolo; Carletti, Monica; Rigatelli, Alberto; Putaala, Jukka; Tatlisumak, Turgut; Masotti, Luca; Lorenzini, Gianni; Tassi, Rossana; Guideri, Francesca; Martini, Giuseppe; Tsivgoulis, Georgios; Vadikolias, Kostantinos; Papageorgiou, Sokratis G.; Corea, Francesco; Sette, Massimo Del; Ageno, Walter; Lodovici, Maria Luisa De; Bono, Giorgio; Baldi, Antonio; D’Anna, Sebastiano; Sacco, Simona; Carolei, Antonio; Tiseo, Cindy; Imberti, Davide; Zabzuni, Dorjan; Doronin, Boris; Volodina, Vera; Consoli, Domenico; Galati, Franco; Pieroni, Alessio; Toni, Danilo; Monaco, Serena; Baronello, Mario M.; Barlinn, Kristian; Pallesen, Lars Peder; Kepplinger, Jessica; Bodechtel, Ulf; Gerber, Johannes; Deleu, Dirk; Melikyan, Gayane; Ibrahim, Faisal; Akhtar, Naveed; Mosconi, Maria G.; Lees, Kennedy R.; Caso, Valeria.

In: European Stroke Journal, Vol. 2, No. 1, 01.03.2017, p. 46-53.

Research output: Contribution to journalArticle

Antonenko, K, Paciaroni, M, Agnelli, G, Falocci, N, Becattini, C, Marcheselli, S, Rueckert, C, Pezzini, A, Poli, L, Padovani, A, Csiba, L, Szabó, L, Sohn, SI, Tassinari, T, Abdul-Rahim, AH, Michel, P, Cordier, M, Vanacker, P, Remillard, S, Alberti, A, Venti, M, Acciarresi, M, D’Amore, C, Scoditti, U, Denti, L, Orlandi, G, Chiti, A, Gialdini, G, Bovi, P, Carletti, M, Rigatelli, A, Putaala, J, Tatlisumak, T, Masotti, L, Lorenzini, G, Tassi, R, Guideri, F, Martini, G, Tsivgoulis, G, Vadikolias, K, Papageorgiou, SG, Corea, F, Sette, MD, Ageno, W, Lodovici, MLD, Bono, G, Baldi, A, D’Anna, S, Sacco, S, Carolei, A, Tiseo, C, Imberti, D, Zabzuni, D, Doronin, B, Volodina, V, Consoli, D, Galati, F, Pieroni, A, Toni, D, Monaco, S, Baronello, MM, Barlinn, K, Pallesen, LP, Kepplinger, J, Bodechtel, U, Gerber, J, Deleu, D, Melikyan, G, Ibrahim, F, Akhtar, N, Mosconi, MG, Lees, KR & Caso, V 2017, '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)', European Stroke Journal, vol. 2, no. 1, pp. 46-53. https://doi.org/10.1177/2396987316679577
Antonenko, Kateryna ; Paciaroni, Maurizio ; Agnelli, Giancarlo ; Falocci, Nicola ; Becattini, Cecilia ; Marcheselli, Simona ; Rueckert, Christina ; Pezzini, Alessandro ; Poli, Loris ; Padovani, Alessandro ; Csiba, Laszló ; Szabó, Lilla ; Sohn, Sung Il ; Tassinari, Tiziana ; Abdul-Rahim, Azmil H. ; Michel, Patrik ; Cordier, Maria ; Vanacker, Peter ; Remillard, Suzette ; Alberti, Andrea ; Venti, Michele ; Acciarresi, Monica ; D’Amore, Cataldo ; Scoditti, Umberto ; Denti, Licia ; Orlandi, Giovanni ; Chiti, Alberto ; Gialdini, Gino ; Bovi, Paolo ; Carletti, Monica ; Rigatelli, Alberto ; Putaala, Jukka ; Tatlisumak, Turgut ; Masotti, Luca ; Lorenzini, Gianni ; Tassi, Rossana ; Guideri, Francesca ; Martini, Giuseppe ; Tsivgoulis, Georgios ; Vadikolias, Kostantinos ; Papageorgiou, Sokratis G. ; Corea, Francesco ; Sette, Massimo Del ; Ageno, Walter ; Lodovici, Maria Luisa De ; Bono, Giorgio ; Baldi, Antonio ; D’Anna, Sebastiano ; Sacco, Simona ; Carolei, Antonio ; Tiseo, Cindy ; Imberti, Davide ; Zabzuni, Dorjan ; Doronin, Boris ; Volodina, Vera ; Consoli, Domenico ; Galati, Franco ; Pieroni, Alessio ; Toni, Danilo ; Monaco, Serena ; Baronello, Mario M. ; Barlinn, Kristian ; Pallesen, Lars Peder ; Kepplinger, Jessica ; Bodechtel, Ulf ; Gerber, Johannes ; Deleu, Dirk ; Melikyan, Gayane ; Ibrahim, Faisal ; Akhtar, Naveed ; Mosconi, Maria G. ; Lees, Kennedy R. ; Caso, Valeria. / 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). In: European Stroke Journal. 2017 ; Vol. 2, No. 1. pp. 46-53.
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abstract = "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.",
author = "Kateryna Antonenko and Maurizio Paciaroni and Giancarlo Agnelli and Nicola Falocci and Cecilia Becattini and Simona Marcheselli and Christina Rueckert and Alessandro Pezzini and Loris Poli and Alessandro Padovani and Laszl{\'o} Csiba and Lilla Szab{\'o} and Sohn, {Sung Il} and Tiziana Tassinari and Abdul-Rahim, {Azmil H.} and Patrik Michel and Maria Cordier and Peter Vanacker and Suzette Remillard and Andrea Alberti and Michele Venti and Monica Acciarresi and Cataldo D’Amore and Umberto Scoditti and Licia Denti and Giovanni Orlandi and Alberto Chiti and Gino Gialdini and Paolo Bovi and Monica Carletti and Alberto Rigatelli and Jukka Putaala and Turgut Tatlisumak and Luca Masotti and Gianni Lorenzini and Rossana Tassi and Francesca Guideri and Giuseppe Martini and Georgios Tsivgoulis and Kostantinos Vadikolias and Papageorgiou, {Sokratis G.} and Francesco Corea and Sette, {Massimo Del} and Walter Ageno and Lodovici, {Maria Luisa De} and Giorgio Bono and Antonio Baldi and Sebastiano D’Anna and Simona Sacco and Antonio Carolei and Cindy Tiseo and Davide Imberti and Dorjan Zabzuni and Boris Doronin and Vera Volodina and Domenico Consoli and Franco Galati and Alessio Pieroni and Danilo Toni and Serena Monaco and Baronello, {Mario M.} and Kristian Barlinn and Pallesen, {Lars Peder} and Jessica Kepplinger and Ulf Bodechtel and Johannes Gerber and Dirk Deleu and Gayane Melikyan and Faisal Ibrahim and Naveed Akhtar and Mosconi, {Maria G.} and Lees, {Kennedy R.} and Valeria Caso",
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journal = "European Stroke Journal",
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TY - JOUR

T1 - Sex-related differences in risk factors, type of treatment received and outcomes in patients with atrial fibrillation and acute stroke

T2 - Results from the RAF-study (Early Recurrence and Cerebral Bleeding in Patients with Acute Ischemic Stroke and Atrial Fibrillation)

AU - Antonenko, Kateryna

AU - Paciaroni, Maurizio

AU - Agnelli, Giancarlo

AU - Falocci, Nicola

AU - Becattini, Cecilia

AU - Marcheselli, Simona

AU - Rueckert, Christina

AU - Pezzini, Alessandro

AU - Poli, Loris

AU - Padovani, Alessandro

AU - Csiba, Laszló

AU - Szabó, Lilla

AU - Sohn, Sung Il

AU - Tassinari, Tiziana

AU - Abdul-Rahim, Azmil H.

AU - Michel, Patrik

AU - Cordier, Maria

AU - Vanacker, Peter

AU - Remillard, Suzette

AU - Alberti, Andrea

AU - Venti, Michele

AU - Acciarresi, Monica

AU - D’Amore, Cataldo

AU - Scoditti, Umberto

AU - Denti, Licia

AU - Orlandi, Giovanni

AU - Chiti, Alberto

AU - Gialdini, Gino

AU - Bovi, Paolo

AU - Carletti, Monica

AU - Rigatelli, Alberto

AU - Putaala, Jukka

AU - Tatlisumak, Turgut

AU - Masotti, Luca

AU - Lorenzini, Gianni

AU - Tassi, Rossana

AU - Guideri, Francesca

AU - Martini, Giuseppe

AU - Tsivgoulis, Georgios

AU - Vadikolias, Kostantinos

AU - Papageorgiou, Sokratis G.

AU - Corea, Francesco

AU - Sette, Massimo Del

AU - Ageno, Walter

AU - Lodovici, Maria Luisa De

AU - Bono, Giorgio

AU - Baldi, Antonio

AU - D’Anna, Sebastiano

AU - Sacco, Simona

AU - Carolei, Antonio

AU - Tiseo, Cindy

AU - Imberti, Davide

AU - Zabzuni, Dorjan

AU - Doronin, Boris

AU - Volodina, Vera

AU - Consoli, Domenico

AU - Galati, Franco

AU - Pieroni, Alessio

AU - Toni, Danilo

AU - Monaco, Serena

AU - Baronello, Mario M.

AU - Barlinn, Kristian

AU - Pallesen, Lars Peder

AU - Kepplinger, Jessica

AU - Bodechtel, Ulf

AU - Gerber, Johannes

AU - Deleu, Dirk

AU - Melikyan, Gayane

AU - Ibrahim, Faisal

AU - Akhtar, Naveed

AU - Mosconi, Maria G.

AU - Lees, Kennedy R.

AU - Caso, Valeria

PY - 2017/3/1

Y1 - 2017/3/1

N2 - 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.

AB - 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.

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U2 - 10.1177/2396987316679577

DO - 10.1177/2396987316679577

M3 - Article

VL - 2

SP - 46

EP - 53

JO - European Stroke Journal

JF - European Stroke Journal

SN - 2396-9873

IS - 1

ER -