Extract
Gender is increasingly recognized as an important modulator of disease presentation and outcome1 as well as for the perception of symptoms and the disease process by the treating physician. Sex hormones importantly affect body function, the risk of developing cardiac disease and natural outcome, as well as that of interventions. For instance, in atrial fibrillation, women have a higher risk of stroke. Indeed, out of a maximum of 9 points on the CHA2DS2-VASc score,2,3 female gender is 1 point. Furthermore, due to their smaller body size and hence distribution volume, among other factors, drugs may act differently in women,4 and with anticoagulants their bleeding risk is also increased. The risk of bleeding is particularly high in patients with coronary artery disease and atrial fibrillation undergoing stenting.5–7
This Focus Issue on gender issues in cardiac patients therefore begins with a Current Opinion on the ‘Management of antithrombotic therapy after bleeding in patients with coronary artery disease and/or atrial fibrillation:expertconsensus paper of the European Society of Cardiology Working Group on Thrombosis’, by Sigrun Halvorsen and colleagues from the ESC Working Group on Thrombosis.8 The authors note that although several recommendations have been published dealing with the acute management of bleeding in patients treated with antithrombotic drugs,9,10 there is an unmet need for guidance on how to manage antithrombotic therapy after bleeding has occurred, particularly now that with idarucizumab, a blocking antibody against dabigatran has become available11 and antagonists for other NOACs (non-vitamin K antagonist oral anticoagulants) are in development. Patients with recent bleeding have been excluded from most randomized trials of antithrombotic therapy, and rigorous evidence to inform decisions is scarce. While waiting for observational and randomized data to accrue, this consensus paper offers a European perspective on managing antithrombotic therapy after bleeding in patients with coronary artery disease and/or atrial fibrillation, including which drugs to stop, which to restart, and when.
