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Antiplatelet treatment in primary and secondary stroke prevention in women

Valeria Caso1, Paola Santalucia, Monica Acciarresi

  • 1Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Sant'Andrea delle Fratte, Perugia, Italy.

European Journal of Internal Medicine
|September 4, 2012
PubMed

Insights

Antiplatelet therapies reduce stroke risk in men, but women are underrepresented in trials. Aspirin shows promise for women

Area of Science:

  • Neurology
  • Cardiovascular Medicine
  • Pharmacology

Background:

  • Stroke is a major global cause of death and disability.
  • Antiplatelet agents have decreased stroke incidence in men but not women.
  • Women are significantly underrepresented in clinical trials for stroke prevention.

Purpose of the Study:

  • To review antiplatelet therapies for primary and secondary stroke prevention (excluding cardioembolic stroke).
  • To analyze sex-based differences in antiplatelet efficacy and safety.
  • To discuss the need for sex-specific antiplatelet strategies for women.

Main Methods:

  • Narrative review of major randomized controlled trials and meta-analyses.
  • Analysis of women's enrollment percentages in key studies.
  • Examination of sex-interaction effects in antiplatelet trials.

Main Results:

  • Most trials lack sex-specific subgroup analyses due to underrepresentation of women.
  • Antiplatelet agents are presumed equally effective for both sexes despite limited evidence.
  • Aspirin demonstrates greater primary prevention benefit for women with no significant increase in hemorrhage risk.

Conclusions:

  • Current evidence on antiplatelets for stroke prevention in women is limited by trial design.
  • There is a critical need for research and development of targeted antiplatelet therapies for women.
  • Aspirin may offer a favorable risk-benefit profile for primary ischemic stroke prevention in women.

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