Antithrombotic drugs for acute coronary syndromes in women: sex-adjusted treatment and female representation in randomised clinical trials. A clinical consensus statement of the European Association of Percutaneous Cardiovascular Interventions (EAPCI) and the ESC Working Group on Thrombosis
Por:
Paradies, V, Masiero, G, Rubboli, A, Van Beusekom, HMM, Costa, F, Capranzano, P, Degrauwe, S, Gorog, DA, Jorge, CM, Buchanan, GL, Alasnag, M, Trabattoni, D, Fraccaro, C, Sibbing, D, Dudek, D, Vilahur, G, Chieffo, A, Mehran, R, Capodanno, D, Barbato, E, Siller-Matula, JM
Publicada:
21 jul 2025
Ahead of Print:
1 may 2025
Resumen:
Thrombotic and bleeding risks differ between sexes, partly in relation to distinct biology and hormonal status, but also due to differences in age, comorbidities, and body size at presentation. Women experience frequent fluctuations of prothrombotic and bleeding status related to menstrual cycle, use of oral contraceptives, hormone replacement therapy, or menopause. Although clinical studies tend to underrepresent women, available data consistently support sex-specific differences in the baseline thrombotic and haemorrhagic risks. Compared with men, women feature an increased risk of in-hospital bleeding related to invasive procedures, as well as long-term out-of-hospital bleeding events. In addition, the inappropriate dosing of antithrombotic drugs, which is not adapted to body weight or renal function, is more frequently associated with an increased risk of bleeding in women compared to men. While acute coronary syndrome (ACS) studies support similar antithrombotic drug efficacy, irrespective of sex, women may receive delayed treatment due to bias in their referral, diagnosis, and invasive treatment decisions. The current clinical consensus statement highlights the need for an increased awareness of sex-specific risks and biases in ACS management, with a focus on sex-specific bleeding mitigation strategies, antithrombotic management in special conditions (e.g., myocardial infarction with non-obstructive coronary arteries), and barriers to female representation in cardiovascular trials. This manuscript aims to provide expert opinion, based on the best available evidence, and consensus statements on optimising antithrombotic therapy according to sex, which is critical to improve sex-based disparities in outcome.
Filiaciones:
Paradies, V:
Maasstad Hosp, Cardiol Dept, Rotterdam, Netherlands
Masiero, G:
Univ Padua, Dept Cardiac Thorac Vasc Sci & Publ Hlth, Intervent Cardiol Unit, Padua, Italy
Rubboli, A:
S Maria delle Croci Hosp, Dept Emergency Cardiol & Internal Med, Div Cardiol, Ravenna, Italy
Van Beusekom, HMM:
Erasmus MC Univ, Dept Cardiol, Med Ctr, Rotterdam, Netherlands
Costa, F:
Hosp Univ Virgen de la Victoria, Dept Med UMA, Area Corazon, IBIMA Plataforma BIONAND, Malaga, Spain
Ctr Invest Biomed Red Enfermedades Cardiovasc CIBE, Malaga, Spain
Univ Messina, Dept Biomed & Dent Sci & Morphol & Funct Images, Messina, Italy
Capranzano, P:
Univ Catania, Azienda Osped Univ Policlin G Rodolico San Marco, Catania, Italy
Degrauwe, S:
Geneva Univ Hosp, Cardiol Dept, Geneva, Switzerland
Gorog, DA:
Imperial Coll, Natl Heart & Lung Inst, Fac Med, London, England
Univ Hertfordshire, Postgrad Med Sch, Hatfield, England
Jorge, CM:
Univ Hosp Santa Maria, Dept Cardiol, Lisbon, Portugal
Buchanan, GL:
North Cumbria Integrated Care NHS Fdn Trust, Cardiol Dept, Carlisle, England
Alasnag, M:
King Fahd Armed Forces Hosp, Cardiac Ctr, Jeddah, Saudi Arabia
Trabattoni, D:
IRCCS, Dept Invas Cardiol, Ctr Cardiol Monzino, Milan, Italy
Fraccaro, C:
Univ Padua, Dept Cardiac Thorac Vasc Sci & Publ Hlth, Intervent Cardiol Unit, Padua, Italy
Sibbing, D:
Ludwig Maximilians Univ LMU Munchen, Dept Cardiol, Munich, Germany
Dudek, D:
Jagiellonian Univ Hosp, Dept Cardiol & Cardiovasc Intervent, Krakow, Poland
Vilahur, G:
Res Inst St Pau IR ST PAU, CIBERCV, Barcelona, Spain
Chieffo, A:
Univ Vita Salute San Raffaele, Milan, Italy
IRCCS San Raffaele Sci Inst, Intervent Cardiol Unit, Milan, Italy
Mehran, R:
Icahn Sch Med Mt Sinai, Cardiovasc Inst, New York, NY USA
Capodanno, D:
Univ Catania, Azienda Osped Univ Policlin G Rodolico San Marco, Catania, Italy
Barbato, E:
Sapienza Univ Rome, Dept Clin & Mol Med, Rome, Italy
Siller-Matula, JM:
Med Univ Vienna, Dept Internal Med 2, Div Cardiol, Vienna, Austria
Green Submitted, Bronze
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