Samuel Z. Goldhaber, MD


June 25, 2015

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A Look at Gender in GARFIELD-AF

Hello. This is Dr Sam Goldhaber from the Clot Blog at on Medscape, recording from the American College of Cardiology Scientific Sessions in San Diego. Today we're going to talk about whether women and men are equal in the GARFIELD-AF[1] observational study.

Women and men have anticoagulation withheld equally, despite guidelines[2] recommending that they receive anticoagulation to prevent stroke. GARFIELD-AF will be, when it is completed, a registry of more than 55,000 patients with atrial fibrillation (AF). It's a global registry looking at real life, in-the-field practice and management of men and women with AF.

We've known for years that women have less AF than men. However, women proportionally more often suffer stroke from AF than men do. In a sense, you could look at AF as a particular problem for women's health. In the history of cardiovascular medicine, there have been other examples where women don't receive as aggressive therapy as men do. For instance, women undergo coronary bypass surgery less often than men, even for the same degree of coronary artery disease.

Stroke Risk and Anticoagulation

So the hypothesis was generated that perhaps women did not receive anticoagulation as much as men did in the presence of a particular CHA2DS2-VASc risk score for stroke with AF. We had 17,000-plus patients to look at in the GARFIELD-AF study so far. What we found is that there was no difference between women and men.[3] Both women and men had withholding of anticoagulation 39% of the time when they had risk for stroke from AF. They had the anticoagulation withheld despite the American[2] and European[4] guidelines to prescribe anticoagulation. This is disappointing.

The Need for Education

We really need to work and spread the word that stroke can often be prevented with anticoagulation in patients who have AF. When we look back to the European Heart Survey[5] that was done more than 10 years ago, what did we find then? Overall, 40% of the patients with AF did not receive anticoagulation. We really haven't moved very far toward protecting our universe of AF patients against stroke.

There is a huge unmet need; a great deal of effort needs to go into education, to really encourage more widespread use of anticoagulation in high-risk patients for stroke from AF.

This does not appear to be an issue where women or men are unequal. They are both being treated equally—39% of each group not receiving the anticoagulation that we would expect according to guidelines.

Our work for us as a cardiovascular community is cut out and set. We have to follow this and see, in subsequent cohorts to be reported from GARFIELD-AF, whether we can reduce the number of unprotected patients.

This is Dr Sam Goldhaber, signing off for the Clot Blog.


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