Intracranial Haemorrhage: Sex, Age, and Treatment – Authors’ Reply
Understanding Bleeding Risks with DOACs in Atrial Fibrillation
For individuals with atrial fibrillation (AFib) and a history of intracerebral hemorrhage, navigating anticoagulant therapy requires careful consideration. Recent research highlights potential differences in bleeding risk based on sex,a crucial factor often overlooked in standard treatment protocols.
Direct oral anticoagulants (DOACs) have become a mainstay in preventing strokes for those with AFib. however, emerging data suggests that men and women may respond differently to these medications, particularly when a prior brain bleed is present. Initial pilot studies indicated a trend toward higher rates of intracranial bleeding in men compared to women.
The PRESTIGE-AF trial further investigated this potential disparity. Analysis of the trial data, as of October 17, 2025, revealed that among 113 women enrolled, 7 (6%) experienced intracranial bleeding. In contrast, 9 (4%) of the 206 men in the study experienced the same complication. While these numbers aren’t dramatically different, they suggest a possible trend warranting further investigation.
PRESTIGE-AF Trial: Intracranial Bleeding Rates by Sex
| Sex | Number of Participants | Number of Intracranial Bleeding Events | Percentage of Participants with Bleeding |
|---|---|---|---|
| Female | 113 | 7 | 6% |
| Male | 206 | 9 | 4% |
The observed numerical difference in bleeding rates underscores the complexity of anticoagulant management. Factors beyond sex, such as age, kidney function, and other medications, also play a significant role.
Researchers are continuing to explore the underlying mechanisms driving these potential sex-based differences. It’s theorized that hormonal influences or variations in body composition may contribute to the observed trends.
If you are taking a DOAC and have afib, especially with a history of intracranial hemorrhage, discuss these findings with your cardiologist or healthcare provider. They can help you assess your individual risk profile and ensure you are receiving the most appropriate and safe treatment plan.