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Platelet function and long-term antiplatelet therapy in women: is there a gender-specificity? A ‘state-of-the-art’ paper

Giuseppe Patti, Raffaele De Caterina, Rosanna Abbate, Felicita Andreotti, Luigi Marzio Biasucci, Paolo Calabrò, Gabriele Cioni, Giovanni Davì, Germano Di Sciascio, Enrica Golia, Paolo Golino, Gelsomina Malatesta, Fabio Mangiacapra, Rossella Marcucci, Annunziata Nusca, Vito Maurizio Parato, Vittorio Pengo, Domenico Prisco, Fabio Pulcinelli, Giulia Renda, Elisabetta Ricottini, Benedetta Ruggieri, Francesca Santilli, Francesco Sofi, Marco Zimarino
DOI: http://dx.doi.org/10.1093/eurheartj/ehu279 2213-2223 First published online: 14 July 2014

Abstract

Although the female gender is generally less represented in cardiovascular studies, observational and randomized investigations suggest that—compared with men—women may obtain different benefits from antiplatelet therapy. Multiple factors, including hormonal mechanisms and differences in platelet biology, might contribute to such apparent gender peculiarities. The thrombotic and bleeding risks, as well as outcomes after a cardiovascular event, appear to differ between genders, partly in relation to differences in age, comorbidities and body size. Equally, the benefits of antiplatelet therapy may differ in women compared with men in different vascular beds, during primary or secondary prevention and according to the type of an antiplatelet agent used. This document is an attempt to bring together current evidence, clinical practices and gaps of knowledge on gender-specific platelet function and antiplatelet therapy. On the basis of the available data, we provide suggestions on current indications of antiplatelet therapy for cardiovascular prevention in women with different clinical features; no strong recommendation may be given because the available data derive from observational studies or post hoc/subgroup analyses of randomized studies without systematic adjustments for baseline risk profiles.

  • Platelets
  • Antiplatelet therapy
  • Thrombosis
  • Gender differences
  • Women
  • Men
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