Unequal prescription of anticoagulants among females and males with atrial fibrillation and similar stroke risk: Should we omit sex category from the CHA2DS2-VASc score?

The CHA2DS2-VASc stroke risk score has been recommended by the European Society of Cardiology atrial fibrillation (AF) guidelines to guide decision on oral anticoagulation (OAC) prescription in AF patients. Although female sex initially was considered an individual risk factor warranting antithrombotic treatment in all female AF patients independent of other risk factors, this recommendation was revised as growing evidence showed that, rather, female sex is a risk modifier, as sex does not contribute to stroke risk in the absence of other risk factors. 1 Hindricks G. Potpara T. Dagres N. et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021; 42: 373-498 Google Scholar Currently, a CHA2DS2-VASc of 2 in females or 1 in males has a class IIa recommendation for OAC (ie, should be considered), and a CHA2DS2-VASc ≥3 in females or ≥2 in males has a class I recommendation for OAC (ie, indicated). 1 Hindricks G. Potpara T. Dagres N. et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021; 42: 373-498 Google Scholar