Balancing ischaemic and bleeding risks in high-risk populations undergoing percutaneous coronary interventions has become an everyday dilemma for clinicians. It is particularly difficult to make decisions concerning combinations and duration of antiplatelet regimens in women given the poor representation of women in trials that have shaped current practice. Several contemporary landmark trials have recently been presented at the American College of Cardiology. The trials included the Harmonising Optimal Strategy for Treatment of coronary artery diseases-EXtended Antiplatelet Monotherapy, Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention and the TicAgrelor versus CLOpidogrel in Stabilised Patients With Acute Myocardial Infarction. In this article, we summarise the main findings of these trials and include the The Polymer-free Drug-Coated Coronary Stents in Patients at High Bleeding Risk (LEADERS FREE) in search for evidence based best practices for women patients. Although some of these trials had prespecified a subanalysis of sex differences, women constituted only 17%–30% of participants making sex-specific analyses challenging. Data suggest that women benefit from de-escalation to both ticagrelor and clopidogrel monotherapy. However, given the increased bleeding risks observed in women further randomised controlled trials are necessary to determine the most appropriate combination and duration of dual antiplatelet therapy as well as maintenance single antiplatelet therapy.

中文翻译：

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当代抗血小板治疗试验中基于性别的结果


平衡接受经皮冠状动脉介入治疗的高危人群的缺血和出血风险已成为临床医生每天面临的难题。鉴于在影响当前实践的试验中女性代表性较差，就女性抗血小板治疗方案的组合和持续时间做出决定尤其困难。美国心脏病学会最近提出了几项当代具有里程碑意义的试验。这些试验包括协调冠状动脉疾病治疗的最佳策略——在冠状动脉介入治疗后的高危患者中延长抗血小板单药治疗、替格瑞洛联合阿司匹林或单药治疗，以及替格瑞洛与氯吡格雷在稳定的急性心肌梗死患者中的比较。在本文中，我们总结了这些试验的主要结果，包括高出血风险患者的无聚合物药物涂层冠状动脉支架（LEADERS FREE），为女性患者寻找基于证据的最佳实践。尽管其中一些试验预先规定了性别差异的亚分析，但女性仅占参与者的 17%–30%，这使得针对性别的分析具有挑战性。数据表明，女性可以从替格瑞洛和氯吡格雷单一疗法的降级治疗中受益。然而，鉴于在女性中观察到的出血风险增加，有必要进行进一步的随机对照试验，以确定双重抗血小板治疗以及维持性单一抗血小板治疗的最合适的组合和持续时间。