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.

2nd Department of Neurology Attikon Hospital University of Athens School of Medicine Athens Greece

Abteilung für Neurologie Oberschwabenklinik gGmbH Ravensburg Germany

Centre Cerebrovasculaire Service de Neurologie Department des Neurosciences Cliniques Centre Hopitalier Universitaire Vaudois Lausanne Switzerland

Clinica Neurologica Azienda Ospedaliero Universitaria Pisa Italy

Department of Clinical and Experimental Sciences Neurology Unit University Health and Wealth of Brescia Italy

Department of Internal Medicine Cecina Hospital Cecina Livorno Italy

Department of Internal Medicine Insubria University Varese Italy

Department of Internal Medicine Ospedale Civile di Piacenza Italy

Department of Neurology and Psychiatry Sapienza University of Rome Italy

Department of Neurology Bogomolets National Medical University Kyiv Ukraine

Department of Neurology Born Bunge Institute Antwerp University Hospital Antwerp Belgium

Department of Neurology Democritus University of Thrace University Hospital of Alexandroupolis Greece

Department of Neurology Dresden University Stroke Center Dresden Germany

Department of Neurology Helsinki University Central Hospital Helsinki Finland

Department of Neurology Keimyung University School of Medicine Daegu South Korea

Department of Neurology Sahlgrenska University Hospital Gothenburg Sweden

Department of Neurology University of L'Aquila Italy

Institute of Neuroscience and Physiology Sahlgrenska Academy at University of Gothenburg Gothenburg Sweden

International Clinic Research Center St Anne's University Hospital Brno Brno Czech Republic

Medical School and Institute of Cardiovascular and Medical Sciences University of Glasgow Glasgow United Kingdom

Municipal Budgetary Healthcare Institution of Novosibirsk City Clinical Hospital Novosibirsk Russia

Neurologia d'urgenza e Stroke Unit Istituto Clinico Humanitas Rozzano Milano Italy

Neurology Hamad Medical Corporation Doha Qatar

SSO Stroke Unit UO Neurologia DAI di Neuroscienze AOUI Verona Italy

Stroke Unit and Division of Cardiovascular Medicine University of Perugia Italy

Stroke Unit AOU Senese Siena Italy

Stroke Unit Department of Neurology Sant'Andrea Hospital La Spezia Italy

Stroke Unit Department of Neurology Santa Corona Hospital Pietra Ligure Italy

Stroke Unit Dipartimento Geriatrico Riabilitativo University of Parma Italy

Stroke Unit Jazzolino Hospital Vibo Valentia Italy

Stroke Unit Neurology Insubria University Varese Italy

Stroke Unit Neuroscience Department University of Parma Italy

Stroke Unit Ospedale Civico Palermo

Stroke Unit Ospedale di Portogruaro Portogruaro Venice Italy

Stroke Unit University of Debrecen Hungary

UO Gravi Cerebrolesioni San Giovanni Battista Hospital Foligno Italy

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