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Background  Despite higher thromboembolism risk, women with atrial fibrillation have lower oral anticoagulation ( OAC ) use compared to men. The influence of the  CHA  2  DS  2 ‐ VAS c score or the introduction of non–vitamin K  OAC s on this relationship is not known.    Methods and Results  Using the  PINNACLE  National Cardiovascular Data Registry from 2008 to 2014, we compared the association of sex with  OAC  use (warfarin or non–vitamin K  OAC s) overall and by  CHA  2  DS  2 ‐ VAS c score and examined temporal trends in  OAC  use by sex. Multivariable regression models assessed the association between sex and  OAC  use in those with  CHA  2  DS  2 ‐ VAS c scores ≥2. Temporal analyses assessed changes in  OAC  use by sex over time. Of the 691 906 atrial fibrillation patients, 48.5% were women. Women were significantly less likely than men to use any  OAC  overall (56.7% versus 61.3%;  P <0.001) and at all levels of  CHA  2  DS  2 ‐ VAS c score (adjusted risk ratio 9% to 33% lower, all  P <0.001). Compared to other thromboembolic risk factors, female sex was associated with lower use of  OAC  (risk ratio 0.90, 95% CI  0.90‐0.91). Over time, non–vitamin K  OAC  use increased at a slightly higher rate in women (56.2% increase per year, 95% CI  54.6% to 57.9%) compared to men (53.6% increase per year, 95% CI  52.0% to 55.2%), yet women remained less likely to receive any  OAC  at all time points ( P <0.001).    Conclusions  Among patients with atrial fibrillation, women were significantly less likely to receive  OAC  at all levels of the  CHA  2  DS  2 ‐ VAS c score. Despite increasing non–vitamin K  OAC  use, women had persistently lower rates of  OAC  use compared to men over time.

journal of the american heart association

Sex Differences in the Use of Oral Anticoagulants for Atrial Fibrillation: A Report From the National Cardiovascular Data Registry ( NCDR  ® )  PINNACLE  Registry