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

Abstract

Background: Antithrombotic therapy is crucial for secondary prevention of cardiovascular disease (CVD), but women with CVD may face increased bleeding complications post-percutaneous coronary intervention (PCI) under antithrombotic therapy. However, women are often underrepresented in clinical trials in this field, so evidence for sex-specific recommendations is lacking. Methods and Results: A search on PubMed was conducted for English-language articles addressing bleeding complications and antithrombotic therapy in women. Despite women potentially showing higher baseline platelet responsiveness than men, the clinical implications remain unclear. Concerning antiplatelet therapy post-PCI, although women have an elevated bleeding risk in the acute phase, no sex differences were observed in the chronic phase. However, women require specific considerations for factors such as age, renal function, and weight when determining the dose and duration of antiplatelet therapy. Regarding anticoagulation post-PCI, direct oral anticoagulants may pose a lower bleeding risk in women compared with warfarin. Concerning triple antithrombotic therapy (TAT) post-PCI for patients with atrial fibrillation, there is a lack of evidence on whether sex differences should be considered in the duration and regimen of TAT. Conclusions: Recent findings on sex differences in post-PCI bleeding complications did not provide enough evidence to recommend specific therapies for women. Further studies are needed to address this gap and recommend optimal antithrombotic therapy post-PCI for women.

Keywords: Anticoagulants; Antiplatelet therapy; Cardiovascular disease; Percutaneous coronary intervention (PCI); Sex.

Figure 1.

Preferred Reporting Items for Reviews and Meta-Analyses (PRISMA) diagram of the articles included in the analysis.

Figure 2.

Sex-based differences in acute-phase bleeding post-PCI under antithrombotic therapy. Forest plots show that female sex is an independent risk factor in acute-phase bleeding after PCI under antithrombotic therapy. Horizontal lines represent 95% confidence intervals (CI) and circles represent hazard ratios or odds ratios. ACS, acute coronary syndrome; CCS, chronic coronary syndrome; NSTE-ACS, non-ST-elevation-acute coronary syndrome; NSTEMI, non-ST-elevation myocardial infarction; STEMI, ST-elevation myocardial infarction.