Gender should not play a role in decision-making for oral anticoagulation in patients with atrial fibrillation, a new study concludes.
The research, published in the European Heart Journal, indicates that removing gender from clinical risk scores could simplify the process of deciding which patients should be given blood thinning medication without compromising on accuracy.
Streamlining the risk stratification process would also contribute to equality in care, according to the study’s authors.
The researchers say the findings contribute to growing evidence to avoid consideration of the patient’s gender when offering this type of medication in atrial fibrillation management.
The findings are in line with the new 2024 European Society of Cardiology (ESC) guidelines, which were presented this month at the ESC Congress in London.
Historical data has reported higher rates of strokes in women with atrial fibrillation, but this is likely associated with other risk factors, such as older age at the time of the stroke and lower anticoagulation rates in women, and higher mortality rates in men.
More recently, gender has been considered a risk modifier. However, international guidelines vary considerably.
To understand whether female gender should play a role in the decision-making process for the prescription of anticoagulants, researchers from the University of Birmingham conducted a large observational study.
The analysis involved 78,852 patients with atrial fibrillation, 28,590 of whom were female.
All patients over the age of 75 and those with a history of a prior stroke were excluded since the use of anticoagulants is standard clinical practice in these groups, regardless of gender.
The research cohort focused on a group of patients where the need for anticoagulation medication was less clear.
Differences between men and women, including age and other health conditions were accounted for.
Using UK primary care electronic health records, the analysis showed women with atrial fibrillation had a lower a rate of death from any cause, stroke or major blood clot, combined, than men. This was mainly due to lower mortality among the women. Rates of stroke, arterial blood clots and vascular dementia did not differ between women and men during the average of five years of follow-up.
The team then examined the effectiveness of the most commonly used global stroke risk assessment tool, the CHA2DS2-VASc score, which is recommended by NICE.
The findings showed that the tool only modestly predicted which patients would go on to have an adverse outcome, like stroke, and when used without gender input (CHA2DS2-VA) the tool had slightly better precision.
Dr Asgher Champsi, clinical research fellow at the University of Birmingham and co-first author of the paper, said: ‘This research questions whether gender should be used to make decisions on the prevention of stroke, blood clots and death in patients with atrial fibrillation.
‘Removing gender from clinical risk scores could streamline risk stratification without compromising accuracy, and contribute to equality in care.’
Dipak Kotecha, Professor of cardiology at the University of Birmingham, added: ‘Healthcare professionals and patients need to be aware of the poor performance of available risk scores.
‘A personalised approach to decision-making on oral anticoagulation is critical to improve outcomes for patients with atrial fibrillation and reduce the huge burden of health and social care costs.
‘Rather than gender, this includes a broader range of factors that can lead to blood clots beyond conventional risk scores.’
A version of this article was originally published by our sister publication Nursing in Practice.
