Gender differences in antithrombotic therapy

Evidence on the management of atherothrombotic diseases derives from clinical trials where women are usually underrepresented; however, it is well known that gender differences in the incidence and clinical presentation of cardiovascular diseases, and in the efficacy and safety of antithrombotic treatment exist. The pathophysiological mechanisms underlying these gender differences are not fully understood, and are likely multifactorial. Among patients with atrial fibrillation, women are at higher risk of stroke than men. The reasons for this elevated risk remain unclear, but may include older age, under-treatment with anticoagulant therapy, and poor anticoagulation control. Few data are available on possible gender differences regarding the efficacy and safety of direct oral anticoagulants. As concerns antiplatelet therapy, the use of aspirin for primary prevention is associated with a higher risk reduction for ischemic stroke in females and for myocardial infarction in males. In the setting of acute coronary syndromes, the female gender is associated with a significantly higher risk of bleeding. These differences could have implications for future sex-specific treatment and prevention strategies for atherothrombotic diseases. However, the inclusion of a larger number of women in randomized trials evaluating cardiovascular outcomes with the use of antithrombotic drugs is needed in order to produce stronger evidencebased recommendations. The aim of this review is to provide an overview of available data on gender differences in antithrombotic therapy, and to analyze the potential reasons accounting for them.