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Gender and anti-thrombotic therapy: from biology to clinical implications

Rossella Marcucci1, Gabriele Cioni, Betti Giusti

  • 1Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50050, Florence, Italy, rossella.marcucci@unifi.it.

Journal of Cardiovascular Translational Research
|January 29, 2014
PubMed

Insights

Cardiovascular diseases affect women disproportionately. Gender influences antithrombotic treatment efficacy and safety, impacting bleeding and ischemic risks differently in women versus men.

Area of Science:

  • Cardiology and Cardiovascular Research
  • Pharmacology and Therapeutics
  • Gender-Specific Medicine

Background:

  • Cardiovascular diseases (CVDs) are the leading cause of death and morbidity in Western countries, particularly affecting American women.
  • Women are underrepresented in clinical trial literature concerning CVDs, despite their significant disease prevalence.
  • Existing evidence highlights gender-based differences in the efficacy and safety of antithrombotic treatments.

Purpose of the Study:

  • To review and summarize the gender-related aspects of antithrombotic treatment in cardiovascular disease.
  • To explore differences in ischemic and bleeding risks between genders concerning antithrombotic therapies.
  • To discuss the implications of physiological differences (body mass, renal function, platelet reactivity) on treatment outcomes.

Main Methods:

  • Review of existing scientific literature and clinical trial data.
  • Analysis of studies reporting gender-specific outcomes for antithrombotic treatments.
  • Examination of physiological factors contributing to gender disparities in treatment response.

Main Results:

  • Women exhibit higher platelet reactivity and a greater prevalence of high on-treatment platelet reactivity with aspirin and clopidogrel.
  • Aspirin use in primary prevention shows greater risk reduction for ischemic stroke in females and myocardial infarction in males.
  • Female gender is linked to a significantly higher risk of bleeding in the context of acute coronary syndromes (ACS).

Conclusions:

  • Gender significantly influences the net clinical benefit of antithrombotic treatment due to variations in efficacy and safety profiles.
  • Physiological differences, including body mass, renal function, and platelet reactivity, contribute to these gender-related treatment disparities.
  • Clinical guidance for antithrombotic therapy requires consideration of these gender-specific aspects for optimal patient management.

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