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Thromb Haemost 2014; 111(03): 385-391
DOI: 10.1160/TH13-04-0347
Review Article
Schattauer GmbH

Female sex as an independent risk factor for stroke in atrial fibrillation: Possible mechanisms

Christina L. Cove
1   Department of Cardiovascular Medicine, Boston University Medical Center, Boston, Massachusetts, USA
,
Christine M. Albert
2   Cardiovascular Division and Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
,
Felicita Andreotti
3   Department of Cardiovascular Sciences, Catholic University, Rome, Italy
,
Lina Badimon
4   Cardiovascular Research Center, CSIC-ICCC, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
,
Isabelle C. Van Gelder
5   University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
,
Elaine M. Hylek
6   Department of Internal Medicine, Boston University Medical Center, Boston, Massachusetts, USA
› Author Affiliations Financial support: This work was supported by the NIH-sponsored Boston University Medical Center Leadership Program in Vascular Medicine K12 HL083781 grant support to Drs. Cove and Hylek. Dr. Hylek also receives funding from the NIH: 1RO1NS070307.
Further Information

Publication History

Received: 28 April 2013

Accepted after major revision: 11 October 2013

Publication Date:
22 November 2017 (online)

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Summary

Atrial fibrillation (AF) is an independent risk factor for thromboembolism and stroke. Women with AF are at a higher overall risk for thromboembolic stroke when compared to men with AF. Recent evidence suggests that female sex, after adjusting for stroke risk profile and sex differences in utilisation of anticoagulation, is an independent stroke risk factor in AF. The inclusion of female sex has improved the accuracy of the CHADS2 stroke risk stratification schema (Congestive heart failure, Hypertension, Age 75 years or greater, Diabetes mellitus, and prior Stroke or TIA). The newly revised and validated schema, CHA2DS2-VASc, dichotomises age and incorporates female sex and vascular disease history. The pathophysiological mechanisms to explain this increased risk in women are not well understood. According to Virchow’s triad, thrombosis that leads to stroke in AF should arise from three co-existing phenomena: structural abnormalities, blood stasis, and a hypercoagulable state. Herein, we explore the sex differences in the biological processes that lead to thrombus formation as applied to Virchow’s Triad. The objective of this review is to describe the potential mechanisms behind the increased risk of stroke in AF associated with female sex.

Keywords

Atrial fibrillation - stroke - sex differences - anticoagulation
 

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