Atrial Fibrillation (AF)
Î Risk stratification tools in AF that account for age- and sex-specific
differences in the incidence of stroke are recommended (I-A).
Î Considering the increased prevalence of AF with age and the higher
risk of stroke in elderly women with AF, active screening (in particular
of women >75 years of age) in primary care settings using pulse taking
followed by an ECG as appropriate is recommended (I-B).
Î Oral anticoagulation in women aged ≤65 years with AF alone (no other
risk factors, women with CHADS
2
=0 or CHA
2
DS
2
-VASc=1) is NOT
recommended (III-B). Antiplatelet therapy is a reasonable therapeutic
option for selected low-risk women (IIa-B).
Î 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 CHA
2
DS
2
-VASc) who do not have a prosthetic heart valve
or hemodynamically significant valve disease, severe renal failure
(creatinine clearance ≤15 mL/min), lower weight (<50 kg), or advanced
liver disease (impaired baseline clotting function) (I-A).
Strategies for Prevention of Stroke in Women
Î Women with asymptomatic carotid stenosis should be screened for other
treatable risk factors for stroke, and appropriate lifestyle changes and
medical therapies should be instituted (I-C).
Î In women who are to undergo CEA, aspirin is recommended unless
contraindicated, because aspirin was used in every major trial that
demonstrated efficacy of CEA (I-C).
Î Prophylactic CEA performed with <3% morbidity/mortality can be
useful in highly selected patients with an asymptomatic carotid stenosis
(minimum 60% by angiography, 70% by validated Doppler ultrasound)
(IIa-A).
Î For women with recent TIA or IS within the past 6 months and ipsilateral
severe (70%-99%) carotid artery stenosis, CEA is recommended if the
perioperative morbidity and mortality risk is estimated to be <6% (I-A).
CHA
2
DS
2
-VASc CHAD
2
