What are the AHA/ASA guidelines on stroke prevention in women with atrial fibrillation (AF)?

Updated: Jan 10, 2016
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The AHA/ASA guidelines note that the prevalence of AF increases with age and women have greater life expectancy; thus, an increase in cases of AF in women compared with men is expected as the population ages. Consequently, active screening (in particular of women >75 years of age) in primary care settings, using pulse taking followed by an electrocardiogram (ECG), is a class I recommendation. AF risk stratification tools in AF that account for age- and sex-specific differences in the incidence of stroke are also recommended (class I).

Oral anticoagulation in women aged ≤65 years with AF alone (CHADS2=0 or 1) is not recommended (class III). However, antiplatelet therapy is a reasonable option for selected low-risk women (class IIa). [12]

New oral anticoagulants are a useful alternative to warfarin for the prevention of stroke and systemic thromboembolism in women with paroxysmal or permanent AF and prespecified risk factors (according to CHA2DS2-VASc) who do not have any of the following (class I) [12] :

  • A prosthetic heart valve or hemodynamically significant valve disease
  • Severe renal failure (creatinine clearance 15 mL/min)
  • Lower weight (<50 kg)
  • Advanced liver disease (impaired baseline clotting function)

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