Sex differences in antithrombotic therapy for coronary artery disease

Abstract

Balanced trial recruitment is needed to build the evidence base for sex stratified care Antithrombotic therapies, comprising antiplatelet agents and anticoagulants, are a cornerstone of secondary prevention in patients with established coronary artery disease. Many randomised controlled trials have evaluated various intensities and combinations of antithrombotic therapy, showing reduced risks of recurrent ischaemic events. However, longstanding concern has existed about the generalisability of these findings to female patients, given the underrepresentation of female patients in cardiovascular trials and the sex based biological differences in response to antithrombotic agents.1 Sex differences in platelet reactivity, vascular biology, and pharmacokinetics have raised the hypothesis that female and male patients may experience different benefit-risk profiles with antithrombotic therapies. Clinically, concern has existed that female patients are more prone to bleeding complications and are therefore less suitable for more intensive treatment strategies. Observational data have also suggested potential sex based disparities in treatment allocation and outcomes, with female patients less likely to be referred for intervention.2 In a linked systematic review and meta-analysis (doi:10.1136/bmj-2024-082974), Piccolo and colleagues examine whether the efficacy and …