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

Mariacarla Gallù,Antonino De Lorenzo,Giulia Marrone,Jacopo Maria Legramante,Nicola Di Daniele,Annalisa Noce

doi:10.1155/2020/1743927

Mariacarla Gallù, Antonino De Lorenzo + Show 4 more

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https://doi.org/10.1155/2020/1743927

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Journal: Cardiovascular Therapeutics	Publication Date: Jun 18, 2020
Citations: 10	License type: CC BY 4.0

Affiliation: University of Rome Tor Vergata

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.

Highlights

There is no doubt that men and women are biologically different in terms of body weight, body surface area, total body water, the distribution of extracellular, and intracellular water, as well as differences in the response to drug treatments
A literature search was conducted on PubMed, electronic database using the keywords “atrial fibrillation” [Title/Abstract] and “Novel Oral Anticoagulants” [Title/Abstract] or “novel oral anticoagulants (NOACs)” [Title/Abstract] or “sex”/“gender” [Title/Abstract] or “thromboembolic risk” [Title/Abstract]
The results indicated that atrial fibrillation (AF) female patients have a significantly higher residual risk of cerebrovascular accidents (CVA)/systemic embolism (SE), when warfarin is prescribed, as compared to men

Summary

Introduction

There is no doubt that men and women are biologically different in terms of body weight, body surface area, total body water, the distribution of extracellular, and intracellular water, as well as differences in the response to drug treatments. The risk for ischemic stroke in women doubles between the ages of 55 and 65, coinciding with the menopausal period, when severe estradiol levels and estrogen receptor reduction occurs. This condition could favour a hypercoagulable state through an increased production of inflammatory cytokines [2]. Several prothrombotic biomarkers, such as D-dimer, von Willebrand factor, and beta-thromboglobulin are present in higher concentrations in patients affected by atrial fibrillation (AF) [3, 4].

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