Sex Differences in Bleeding Risk Associated With Antithrombotic Therapy Following Percutaneous Coronary Intervention

Area of Science:

• Cardiovascular Medicine
• Pharmacology
• Clinical Research

Background:

• Antithrombotic therapy is vital for secondary prevention of cardiovascular disease (CVD).
• Women with CVD may experience increased bleeding post-percutaneous coronary intervention (PCI) but are underrepresented in clinical trials.
• Evidence for sex-specific antithrombotic therapy recommendations is limited.

Purpose of the Study:

• To review current evidence on sex differences in bleeding complications associated with antithrombotic therapy post-PCI.
• To identify gaps in knowledge regarding optimal antithrombotic strategies for women.

Main Methods:

• A PubMed search was conducted for English-language articles on bleeding complications and antithrombotic therapy in women.
• Literature review focusing on antiplatelet therapy, anticoagulation, and triple antithrombotic therapy (TAT) post-PCI.

Main Results:

• Women may have higher baseline platelet responsiveness, but clinical implications are unclear.
• Women show elevated acute bleeding risk post-PCI with antiplatelet therapy, but no chronic phase differences were observed.
• Considerations for age, renal function, and weight are crucial for antiplatelet dosing in women.
• Direct oral anticoagulants might offer a lower bleeding risk than warfarin for women post-PCI.
• Insufficient evidence exists to guide sex-specific TAT duration or regimens for women with atrial fibrillation.

Conclusions:

• Current findings on sex differences in post-PCI bleeding do not support specific therapy recommendations for women.
• Further research is essential to establish optimal antithrombotic therapies tailored for women post-PCI.