{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T04:21:50Z","timestamp":1794025310119,"version":"4.8.0"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"ARISTOTELES project"},{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007601","name":"Horizon 2020","doi-asserted-by":"publisher","award":["101080189"],"award-info":[{"award-number":["101080189"]}],"id":[{"id":"10.13039\/501100007601","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"name":"AFFIRMO project on multimorbidity","award":["899871"],"award-info":[{"award-number":["899871"]}]},{"name":"TARGET project","award":["101136244"],"award-info":[{"award-number":["101136244"]}]},{"name":"ARISTOTELES project","award":["101080189"],"award-info":[{"award-number":["101080189"]}]},{"name":"EU\u2019s Horizon Europe Research & Innovation programme"},{"name":"AFFIRMO project"},{"name":"European Union\u2019s Horizon 2020","award":["899871"],"award-info":[{"award-number":["899871"]}]},{"name":"European Union\u2019s Horizon 2020","award":["899871"],"award-info":[{"award-number":["899871"]}]},{"name":"ARISTOTELES project"},{"name":"European Union within the Horizon 2020","award":["101080189"],"award-info":[{"award-number":["101080189"]}],"id":[{"id":"https:\/\/ror.org\/019w4f821","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,19]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>The role of female sex in stroke risk and oral anticoagulant (OAC) use in atrial fibrillation (AF) remains controversial. This study evaluates sex-specific differences in OAC prescription, residual risk of stroke\/TIA and systemic thromboembolism (STE), and the predictive performance of CHA2DS2-VASc vs. CHA2DS2-VA scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We analysed data from a European prospective cohort. The association between female sex and OAC prescription was assessed in patients with CHA2DS2-VA score \u2265 1. We analysed the residual STE risk in OAC-treated patients and compared the predictive performance of CHA2DS2-VASc and CHA2DS2-VA scores. Among 10 080 patients [41.8% women; mean age 70.1 (SD 10.0) years] with CHA2DS2-VA \u22651, women had higher burden of comorbidities and less likely to receive OACs than men (OR 0.79, 95% CI: 0.69\u20130.90). In OAC-treated patients, STE rates were higher in women (IR 1.33 vs. 0.94 per 100 person\u2013years). After adjusting for confounders and the competing risk of death, female sex was not statistically significantly associated with an increased risk of STE (sHR 1.24, 95% CI 0.89\u20131.74, P = 0.210). CHA2DS2-VA and CHA2DS2-VASc scores had similar predictive performance (AUC 0.603 vs. 0.605, P = 0.665). CHA2DS2-VA showed worse (i.e. negative) reclassification compared with CHA2DS2-VASc (net reclassification index \u22120.088, 95% CI \u22120.164 to \u22120.001), with no significant differences in discrimination or net benefit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In AF patients treated with OAC, the increased residual risk of STE associated with female sex was non-significant after adjusting for confounders and the competing risk of death. Both scores had similar predictive performance but CHA2DS2-VA showed worse reclassification compared with CHA2DS2-VASc.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjqcco\/qcaf075","type":"journal-article","created":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T11:55:09Z","timestamp":1754049309000},"page":"1329-1339","source":"Crossref","is-referenced-by-count":23,"title":["Atrial fibrillation and female sex: use of oral anticoagulants in a large European cohort and residual risk of thromboembolism and stroke"],"prefix":"10.1093","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-6345-3742","authenticated-orcid":false,"given":"Davide Antonio","family":"Mei","sequence":"first","affiliation":[{"name":"Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena , Modena 41124 ,","place":["Italy"]},{"name":"Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia , Modena 41124 ,","place":["Italy"]},{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital , Liverpool L14 3PE ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3788-8942","authenticated-orcid":false,"given":"Giulio Francesco","family":"Romiti","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital , Liverpool L14 3PE ,","place":["UK"]},{"name":"Department of Translational and Precision Medicine, Sapienza\u2014University of Rome , Roma 00161, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5196-6249","authenticated-orcid":false,"given":"Marco","family":"Vitolo","sequence":"additional","affiliation":[{"name":"Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena , Modena 41124 ,","place":["Italy"]},{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital , Liverpool L14 3PE ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3403-3364","authenticated-orcid":false,"given":"Jacopo Francesco","family":"Imberti","sequence":"additional","affiliation":[{"name":"Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena , Modena 41124 ,","place":["Italy"]},{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital , Liverpool L14 3PE ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9460-4435","authenticated-orcid":false,"given":"Bernadette","family":"Corica","sequence":"additional","affiliation":[{"name":"Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena , Modena 41124 ,","place":["Italy"]},{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital , Liverpool L14 3PE ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7290-5361","authenticated-orcid":false,"given":"Marta","family":"Mantovani","sequence":"additional","affiliation":[{"name":"Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena , Modena 41124 ,","place":["Italy"]},{"name":"Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia , Modena 41124 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2766-5286","authenticated-orcid":false,"given":"Niccol\u00f2","family":"Bonini","sequence":"additional","affiliation":[{"name":"Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena , Modena 41124 ,","place":["Italy"]},{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital , Liverpool L14 3PE ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7246-7708","authenticated-orcid":false,"given":"Francisco","family":"Marin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, CIBERCV , Murcia 30120 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3823-3809","authenticated-orcid":false,"given":"Igor","family":"Diemberger","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Institute of Cardiology, University of Bologna, Policlinico S.Orsola-Malpighi , via Massarenti 9, Bologna 40138 ,","place":["Italy"]},{"name":"Dipartimento Cardio-Toraco-Vascolare, UOC di Cardiologia, IRCCS Azienda Ospedaliero-Universitaria di Bologna , via Massarenti 9, Bologna 40138 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gheorghe Andrei","family":"Dan","sequence":"additional","affiliation":[{"name":"\u2018Carol Davila\u2019 University of Medicine, Colentina University Hospital , Bucharest 020125 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H","family":"Lip","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital , Liverpool L14 3PE ,","place":["UK"]},{"name":"Department of Clinical Medicine, Aalborg University , Aalborg DK-9220 ,","place":["Denmark"]},{"name":"Medical University of Bialystok , Bialystok 15-089 ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9820-4815","authenticated-orcid":false,"given":"Giuseppe","family":"Boriani","sequence":"additional","affiliation":[{"name":"Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena , Modena 41124 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