Background: Oral anticoagulants (OACs) reduce stroke risk in atrial fibrillation (AF) patients. Little is known about the differential prescription patterns of OACs and outcomes in AF patients when categorized by male versus female sex. The primary objectives of this study were to examine association of sex with likelihood of OAC prescription and with risk of major bleeding (MB), stroke and systemic embolism (SE) among newly diagnosed atrial fibrillation patients.

Methods: Newly diagnosed AF patients age ≥18 and with a CHA2DS2-VASc score ≥2 were identified from the IQVIA PharMetrics database (January 1, 2013 -April 30, 2021). Patients were categorized based on sex (male versus female), and patients were further characterized as receiving an OAC prescription versus not. Multivariable logistic regression was used to estimate odds ratios for OAC prescription. Multivariable Cox models was used estimate hazard ratios for MB and stroke/SE. Models were adjusted for demographics, comorbidities, and medication use.

Results: A total of 244,507 AF patients were identified, of whom 145,117 (59.4%) did not have a claim for an OAC and 99,390 (40.6%) were prescribed an OAC during the study identification period. Males had a slightly higher likelihood of receiving an OAC prescription compared to females (OR 1.07 [95% CI 1.05- 1.10]).There was not a statistically significant difference in overall MB, intracranial or other bleed risk between males and females, but males had a 10% higher risk(95% CI (1.06-1.15)) of gastrointestinal (GI) bleeding compared to females. Males had a 7% lower risk (95% (CI 0.90-0.97)) of all stroke outcomes, 8% lower risk (95% CI (0.89-0.96)) of ischemic stroke, and 25% lower risk (95% CI (0.63-0.89)) of SE as compared to females. There was not a statistically significant difference in the risk of hemorrhagic stroke between males and females.

Conclusion: After adjusting for demographics, comorbidities and medication use, males with AF had a slightly higher likelihood of receiving an OAC prescription, and were also at a slightly higher risk of GI bleeding than females with AF, but were at lower risk of stroke and SE.

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