Atrial fibrillation-related stroke in women: Evidence and inequalities in epidemiology, mechanisms, clinical presentation, and management

Anna Kostopoulou*, Hrvojka M. Zeljko, Harilaos Bogossian, Radu Ciudin, Francisco Costa, Jordi Heijman, Simon Kochhaeuser, Sime Manola, Daniel Scherr, Manav Sohal, Reza Wakili, Michael Wolf, Ghazala Irfan, DAS-CAM participants 2017–2018

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

Abstract

Background Atrial fibrillation (AF) is the most common clinical arrhythmia and one of the major causes of stroke, heart failure, sudden death, and cardiovascular morbidity. Despite substantial advances in (interventional) rhythm control treatment during the last decade, anticoagulation for stroke prevention remains a major component of AF treatment. Hypothesis There are important sex-specific differences in AF-related stroke, resulting from sex-specific mechanisms and therapeutic differences. Methods This review summarizes available data on sex differences in risk assessment and prevention of stroke and highlights current knowledge gaps in AF-related stroke mechanisms, prevention and management that warrant further research. Results Increased thrombotic risk in women is multifactorial, involving hormonal changes after menopause, structural, endocrine and lifestyle/social factors and their interactions. It is clear from randomized studies that women benefit from anticoagulant treatment and that their bleeding risk is similar to men. Women should therefore receive equivalent treatment to men, based on the validated criteria for anticoagulation therapy. However, women are not represented equally in the large randomized studies and sex-related information in many fields is lacking. Conclusions Female sex is an established risk factor for stroke in AF patients. The evidence for sex-specific differences in stroke risk assessment and stroke prevention is accumulating. However, the underlying biological mechanisms remain incompletely understood and further studies are required in order to decrease AF-related morbidity and mortality.

Original languageEnglish
Pages (from-to)14-23
Number of pages10
JournalClinical Cardiology
Volume43
Issue number1
Early online date6 Nov 2019
DOIs
Publication statusPublished - Jan 2020

Keywords

  • anticoagulation
  • atrial fibrillation
  • hemorrhage
  • menopause
  • sex differences
  • stroke
  • HORMONE REPLACEMENT THERAPY
  • GENDER-DIFFERENCES
  • ISCHEMIC-STROKE
  • RISK-FACTORS
  • CATHETER ABLATION
  • HEART-DISEASE
  • OPEN-LABEL
  • FOLLOW-UP
  • WARFARIN
  • ANTICOAGULATION

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