title: Antiplatelet treatment in primary and secondary stroke prevention in women.
abstract: Stroke is a leading cause of death worldwide and the first cause of disability in the Western world. Over the last 20 years, antiplatelet agents have reduced overall stroke rates in primary and secondary prevention in men. However, this has not been the case for women. In this narrative review, the most widely used antiplatelet therapies for primary and secondary prevention in stroke, excluding cardioembolic stroke, will be outlined. First, the largest randomised controlled trials will be analysed as well as the enrolment percentages of women. Second, analyses on sex-interaction effects in each study will be examined. Moreover, the Authors will discuss the need to develop targeted antiplatelet therapies specifically for women. Based on current results, the most randomised clinical trials and meta-analyses on antiplatelet agents in cerebrovascular disease have not performed sub-analyses on sex-related differences and this is mainly because women were underrepresented. Despite this, antiplatelet agents are considered to be equally effective for both sexes in primary and secondary stroke prevention. Finally, aspirin is the most widely studied antiplatelet in women and has been shown to provide greater benefit for women as primary prevention of ischemic stroke without a significant increased risk in haemorrhage.
authors.affiliation: Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Sant'Andrea delle Fratte, Perugia, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Caso
authors.forename: Paola
authors.initials: P
authors.lastname: Santalucia
authors.forename: Monica
authors.initials: M
authors.lastname: Acciarresi
authors.forename: Francesca Romana
authors.initials: FR
authors.lastname: Pezzella
authors.forename: Maurizio
authors.initials: M
authors.lastname: Paciaroni
mesh_terms: D001241:Aspirin / Q000627:therapeutic use; D000077144:Clopidogrel; D004176:Dipyridamole / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D009281:Naphthalenes / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011322:Primary Prevention / Q000379:methods; D011422:Propionates / Q000627:therapeutic use; D012459:Salicylates / Q000627:therapeutic use; D055502:Secondary Prevention / Q000379:methods; D012737:Sex Factors; D020521:Stroke / Q000517:prevention & control*; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D009281:Naphthalenes; D010975:Platelet Aggregation Inhibitors; D011422:Propionates; D012459:Salicylates; C016167:triflusal; D004176:Dipyridamole; C501362:terutroban; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin