Female Sex as a Thromboembolic Risk Factor in the Era of Nonvitamin K Antagonist Oral Anticoagulants

Abstract

Sex-specific differences have been definitively demonstrated in cardiovascular (CV) diseases. These differences can also impact on the effects of CV therapies. Female sex is recognized as an independent predictor of thromboembolic risk, particularly in older patients. Most of strokes are due to atrial fibrillation (AF). Women affected by AF have higher stroke risk compared to men. The introduction of novel oral anticoagulants (NOACs) for long-term anticoagulation completely changed the anticoagulant therapeutic approach and follow-up of patients affected by nonvalvular atrial fibrillation (NVAF). CHA2DS2-VASc stroke risk scoring in use in the current international guidelines attributes 1 point to “female sex”. Besides, no anticoagulation is indicated for AF female patients without other risk factors. Interestingly, NOACs seem to normalize the differences between males and females both in terms of safety and efficacy, whereas residual higher stroke risk and systemic embolism persist in AF women treated with vitamin K antagonist anticoagulants VKA with optimal time in therapeutic range. Based on the CHA2DS2-VASc score, NOACs represent the preferred choice in NVAF patients. Moreover, complete evaluation of apparently lower risk factor along with concomitant clinical conditions in AF patients appears mandatory, particularly for female patients, in order to achieve the most appropriate anticoagulant treatment, either in male or in female patients. The present review was performed to review sex differences in AF-related thromboembolic risk reported in the literature and possibly highlight current knowledge gaps in prevention and management that need further research.

Vegan Diet Health Benefits in Metabolic Syndrome

“…In this context, a study conducted by Key et al on vegetarians highlighted that the death rate for coronary heart disease was 24% lower in subjects that followed a PBD compared to omnivores [ 106 ]. In a further meta-analysis conducted by Kwok et al, the mortality rate for stroke was 22% lower in men that followed PBD compared to omnivores, but this association was not significant among women, demonstrating a gender-dependent effect [ 107 , 108 ].…”

Effects of Caloric Restriction Diet on Arterial Hypertension and Endothelial Dysfunction

“…Left ventricular hypertrophy (LVH) can be described as the thickening of the ventricular wall caused to cope with the overload imposed to the heart for offset peripheral resistances, hence the increase in BP. LVH may occur in both sexes and leads to an increase in either oxygen consumption or energy expenditure of cardiac output [ 90 , 91 ].…”

Predicaments of the appendage

“…Interestingly, women receiving vitamin k antagonists still have a higher risk of stroke compared with men. The sex‐based difference in the risk of thromboembolic events has been removed by the use of direct oral anticoagulants (DOAC) 3 . However, women undergoing catheter ablation encounter a higher risk of 30‐day complications, namely hemorrhage and tamponade, as well as a higher rate of rehospitalization for AF with a much lower likelihood of receiving a repeat AF ablation procedure or cardioversion 4 .…”

“…The sex-based difference in the risk of thromboembolic events has been removed by the use of direct oral anticoagulants (DOAC). 3 However, women undergoing catheter ablation encounter a higher risk of 30-day complications, namely hemorrhage and tamponade, as well as a higher rate of rehospitalization for AF with a much lower likelihood of receiving a repeat AF ablation procedure or cardioversion. 4 As for left atrial appendage occlusion (LAAO), only 30% of those enrolled in the relevant trials were women making it difficult to extrapolate meaningful conclusions.…”