Coronary disease & ACSMeta-analysis
Sex related differences in efficacy and safety of antithrombotic therapy in patients with coronary artery disease: systematic review and meta-analysis
- Systematic review and meta-analysis of randomised trials
- within-trial framework
- inverse variance model
- Ovid Medline and Embase, inception to April 2025
- Patients enrolled 1999–2025
Authors' conclusion
Antithrombotic therapies in patients with established coronary artery disease provided consistent efficacy and safety outcomes in women and men.
Study context
- Population
- Patients with established CAD in RCTs reporting sex-stratified outcomes
- Participants
- 274,433 patients · 33 RCTs
- Comparison
- More intensive vs less intensive antithrombotic therapy, by sex
- Womenn = 72,601
Pooled result
As reported in the abstract
All-cause death: sex interaction (more vs less intensive therapy)
Interaction HR
1.06
95% CI 0.94–1.19
P = 0.33 for interaction
Women vs Men
interaction HR 1.06 (95% CI 0.94–1.19); P for interaction = 0.33
Further pooled results
| Outcome | interaction HR (95% CI) | P value | |
|---|---|---|---|
| MI: sex interaction (more vs less intensive therapy) | 1.05 (0.95–1.17) | P for interaction = 0.36 | |
| 0.512Interaction hr (log scale) |
- MI: sex interaction (more vs less intensive therapy): I2=14.05%; P for heterogeneity=0.28; 7558 MIs among 172 504 patients
- MI: sex interaction (more vs less intensive therapy): interaction P=0.36
MI: sex interaction (more vs less intensive therapy)
- More intensive therapy reduced MI risk by ~15% in both men and women
Safety
events
| Outcome | More intensive | Less intensive | interaction HR (CI) | P value | |
|---|---|---|---|---|---|
| Major bleeding, sex interaction (more vs less intensive antithrombotic therapy) · I2=33.56%; P for heterogeneity=0.05 | 2384 | 1619 | 0.99 (0.86–1.15) | P for interaction = 0.93 | |
| 0.512Interaction hr (log scale) |
- Major bleeding, sex interaction (more vs less intensive antithrombotic therapy): 4003 major bleeding events overall
Major bleeding, sex interaction (more vs less intensive antithrombotic therapy)
- Major bleeding increased by ~40% with more intensive therapy irrespective of sex
Original publication
Sex related differences in efficacy and safety of antithrombotic therapy in patients with coronary artery disease: systematic review and meta-analysis. BMJ. Published 29 July 2025. doi:10.1136/bmj-2024-082974
Summarised from the published abstract; every number is checked against it