A Focused Review of Gender Differences in Antithrombotic Therapy

Abstract

Background: The biological differences among male and female, based on distinctive expression of sex chromosomes, on varied gene-expression and on peculiar sexual hormones, lead to important differences in physiology and pathophysiology.

Objective: The aim of this work was to briefly review the relationships among genderrelated differences and clinical implications in antithrombotic therapy, that could be related to sex-differences in platelet biology and coagulation reactions.

Results: The major clinical setting in which antithrombotic drugs are involved for the treatment are atrial fibrillation, venous thromboembolisn, coronary artery disease and peripheral artery diseases. Considering that a consistent body of evidences suggests that, on one hand, human platelet activity may be influenced by sex and sex hormones and, on the other hand, estrogens are likely to play a crucial role on the transcriptional regulation of coagulation protein genes, the real impact of gender-related differences is still unclear. Moreover, women and men present different responses to antithrombotic drugs, reflecting genderspecific variances in pharmacokinetic profile, along with the physiological characteristics of each gender. Thus, the efficacy and adverse effects of antithrombotic drugs may vary according to gender.

Conclusion: Several gender-related differences could be reported in haemostasis and thrombosis pathophysiological mechanisms. Moreover, several data documented relevant gender differences in antithrombotic management and clinical effectiveness. Further studies are still needed to completely elucidate these issues.

Keywords: Gender; NOACs; antiplatelet drugs; antithrombotic therapy; coagulation system; oral anticoagulant therapy; platelets activity; vitamin K antagonist.