Sex differences in antiplatelet therapy: state-of-the art

Area of Science:

• Cardiology
• Pharmacology
• Sex Differences in Medicine

Background:

• Current antiplatelet therapy guidelines for cardiovascular disease (CVD) secondary prevention are predominantly based on male-centric clinical trial data.
• Women are underrepresented in these trials, resulting in insufficient and inconsistent evidence regarding the efficacy and safety of antiplatelet drugs in this population.
• Reported sex differences in platelet reactivity, patient management, and clinical outcomes underscore the need to investigate sex-specific antiplatelet strategies.

Approach:

• This review synthesizes current knowledge on how biological sex influences platelet biology and response to antiplatelet agents (aspirin, P2Y12 inhibitors, dual antiplatelet therapy).
• It examines the clinical challenges arising from sex and gender differences in the context of CVD management.
• The review also explores potential improvements in cardiological care tailored to women.

Key Points:

• Sex influences platelet function and response to antiplatelet medications, impacting treatment effectiveness.
• Clinical management and outcomes of antiplatelet therapy can differ between sexes, necessitating a sex-specific approach.
• There is a critical need to address the distinct characteristics and requirements of female and male patients with CVD.

Conclusions:

• Existing antiplatelet therapy guidelines may not be optimal for women due to underrepresentation in clinical trials.
• Sex-specific considerations in platelet biology and drug response are crucial for improving CVD secondary prevention in women.
• Further research is essential to refine antiplatelet strategies and enhance cardiological care for female patients with cardiovascular diseases.