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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.

Sex‐Specific Associations of Oral Anticoagulant Use and Cardiovascular Outcomes in Patients With Atrial Fibrillation