Sex Differences Among Patients With High Risk Receiving Ticagrelor With or Without Aspirin After Percutaneous Coronary Intervention

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Abstract
Prolonged dual antiplatelet therapy (DAPT) with a P2Y12 receptor inhibitor and aspirin has been proven to decrease the risk of ischemic events after percutaneous coronary intervention (PCI) but is also associated with an increase in bleeding.1 Recently, the Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention (TWILIGHT) study2 has shown that monotherapy with a potent P2Y12 inhibitor after a short period of DAPT compared with continued DAPT leads to reduced bleeding without an increase in ischemic events among patients at high risk for bleeding or ischemic events after PCI. Whether these effects vary in relation to sex remains unknown. This distinction is clinically relevant as women have an increased risk for bleeding after PCI compared with men.3,4 While these associations may reflect differences in baseline risk factors (eg, older age, kidney impairment) that are more common in women, other reports suggest an independent biological association of female sex with hemorrhagic risk. Accordingly, we performed a prespecified secondary analysis to explore sex differences in the TWILIGHT population and to evaluate the association of sex with outcomes among patients treated with ticagrelor monotherapy vs ticagrelor plus aspirin.

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