A recent British study published in European Heart Journal has reignited discussions on the role of sex as a determinant in prescribing anticoagulants, particularly for patients under the age of 65. The study focused on patients diagnosed with atrial fibrillation (AF), a condition associated with an increased risk of stroke and thromboembolic events. Researchers examined the outcomes of individuals under 65 years of age, comparing their risk profiles and clinical outcomes when stratified by sex. The study found that in the absence of other risk factors—such as hypertension, diabetes, or a history of cardiovascular disease—the baseline risk of thromboembolism for younger patients was low, regardless of sex.
One of the more striking conclusions was that using female sex as a singular risk factor for anticoagulation might not be warranted in younger populations. The study suggested that while older women with comorbidities are indeed at higher risk, the same cannot be generalized to younger women with no additional risk factors.
Anne B. Curtis, MD, Professor of Medicine at the Jacobs School of Medicine & Biomedical Sciences stated, “Putting aside the question of female sex, there are not a lot of people under the age of 65 years with ‘absolutely no risk factors,’ and so, ‘if the only reason you would anticoagulate’ someone of that age is because they are a woman, that ‘doesn’t make a lot of sense to me.’”
The CHA₂DS₂-VASc score, a widely used tool for assessing stroke risk in AF patients, assigns a point for female sex, categorizing women as higher risk compared to men with the same clinical profile. While this approach has been instrumental in guiding treatment decisions, its application to younger women has been increasingly questioned.
The study highlighted that the inclusion of female sex in the scoring system might lead to over-treatment in low-risk patients. For example, a 50-year-old woman with AF but no other comorbidities could receive a higher CHA₂DS₂-VASc score solely due to her sex, prompting unnecessary anticoagulation.
The British study is part of a larger shift in medicine toward precision and personalized care. By incorporating more personalized strategies into anticoagulation decisions, clinicians can ensure that treatments are both effective and safe. As research continues to challenge traditional practices, the medical community must remain open to adapting its approaches to serve patients better.
Sources: European Heart Journal, Medscape
