Sex-specific differences have been definitively demonstrated in cardiovascular (CV) diseases. These differences can also impact on the effects of CV therapies. Female sex is recognized as an independent predictor of thromboembolic risk, particularly in older patients. Most of strokes are due to atrial fibrillation (AF). Women affected by AF have higher stroke risk compared to men. The introduction of novel oral anticoagulants (NOACs) for long-term anticoagulation completely changed the anticoagulant therapeutic approach and follow-up of patients affected by nonvalvular atrial fibrillation (NVAF). CHA2DS2-VASc stroke risk scoring in use in the current international guidelines attributes 1 point to “female sex”. Besides, no anticoagulation is indicated for AF female patients without other risk factors. Interestingly, NOACs seem to normalize the differences between males and females both in terms of safety and efficacy, whereas residual higher stroke risk and systemic embolism persist in AF women treated with vitamin K antagonist anticoagulants VKA with optimal time in therapeutic range. Based on the CHA2DS2-VASc score, NOACs represent the preferred choice in NVAF patients. Moreover, complete evaluation of apparently lower risk factor along with concomitant clinical conditions in AF patients appears mandatory, particularly for female patients, in order to achieve the most appropriate anticoagulant treatment, either in male or in female patients. The present review was performed to review sex differences in AF-related thromboembolic risk reported in the literature and possibly highlight current knowledge gaps in prevention and management that need further research.

中文翻译：

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女性作为非维生素K拮抗剂口服抗凝剂时代的血栓栓塞危险因素。

在心血管疾病中已明确证明了性别特异性差异。这些差异也会影响CV治疗的效果。女性被认为是血栓栓塞风险的独立预测因子，尤其是在老年患者中。大多数中风是由于房颤（AF）引起的。与男性相比，受房颤影响的女性患中风的风险更高。用于长期抗凝的新型口服抗凝剂（NOAC）的引入完全改变了抗凝治疗方法和对患有非瓣膜性房颤（NVAF）的患者的随访。当前国际准则中使用的CHA2DS2-VASc中风风险评分将1分归因于“女性”。此外，对于没有其他危险因素的房颤女性患者，未建议进行抗凝治疗。有趣的是 NOAC似乎可以使男性和女性之间的安全性和功效方面的差异正常化，而在接受维生素K拮抗剂抗凝剂VKA治疗的AF女性中，仍存在治疗风险的最佳时间，即残留中风风险和全身性栓塞。根据CHA2DS2-VASc分数，NOAC代表NVAF患者的首选。此外，为了在男性或女性患者中获得最合适的抗凝治疗，对AF患者尤其是女性患者，必须对明显较低的危险因素以及随之而来的临床状况进行全面评估。