Female Sex as a Risk Modifier for Stroke Risk in Atrial Fibrillation: Using CHA2DS2-VASc versus CHA2DS2-VA for Stroke Risk Stratification in Atrial Fibrillation: A Note of Caution

Peter Brønnum Nielsen; Thure Filskov Overvad

doi:10.1055/s-0040-1710014

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2020; 120(06): 894-898
DOI: 10.1055/s-0040-1710014

Review Article

Georg Thieme Verlag KG Stuttgart · New York

Female Sex as a Risk Modifier for Stroke Risk in Atrial Fibrillation: Using CHA₂DS₂-VASc versus CHA₂DS₂-VA for Stroke Risk Stratification in Atrial Fibrillation: A Note of Caution

Peter Brønnum Nielsen

¹Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark

²Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark

,

Thure Filskov Overvad

²Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark

³Department of Oncology, Aalborg University Hospital, Aalborg, Denmark

› Author Affiliations

Abstract

Stroke prevention is a key clinical concern in the management of patients with atrial fibrillation. Oral anticoagulation treatment reduces the risk of disabling stroke, but the treatment increases the risk of bleeding. For decades, the decision to initiate oral anticoagulation has been guided by clinical risk scoring systems such as the CHADS₂ and CHA₂DS₂-VASc scores. In this narrative review, we focus on the recent discussion of the “Sc” (Sex Category) criterion in the CHA₂DS₂-VASc score. Epidemiological considerations when assessing stroke rates in cohorts are discussed, and the implications of different methodological approaches are outlined. Next, we review studies investigating the association of the “Sc” criterion on the stroke rates under various approaches. Lastly, we discuss potential consequences of implementing the recently suggested sex-less CHA₂DS₂-VA score, which leaves out female sex from stroke risk assessment in atrial fibrillation.

Keywords

stroke/prevention - cardiology - epidemiological studies

Full Text

References

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