Summary box 1. Suggestions on antiplatelet therapy for primary cardiovascular prevention in non-diabetic women.
Calculations of risk were performed according to the SCORE system adopted by the European Society of Cardiology
(http://www.escardio.org/communities/EACPR/toolbox/health-professionals/Pages/SCORE-Risk-Charts.aspx)
Setting
Suggestions
Overall
- Low-dose aspirin (≤100 mg/day) should probably be given in women with a
risk of >2 major cardiovascular events (death, myocardial infarction and
stroke)/100 patients-year (the bleeding risk must be weighted)87. Examples:
 Spanish (low-risk) smoker women with age 60-64 yrs, total cholesterol
levels ≥8 mmol/L (309 mg/dL) and systolic blood pressure ≥150 mmHg
 Austrian (high-risk) smoker women with age ≥65 yrs, total cholesterol
levels ≥6 mmol/L (232 mg/dL), independent of systolic blood pressure.
Low-dose aspirin may be considered in women with a risk of >1
cardiovascular events/100 patients-year (the bleeding risk - increased by aspirin
and the risk of cancer, especially colon cancer, likely reduced by aspirin - along
with patients’ values and preferences, should be considered).87 Examples:
 French (low-risk) smoker women with age ≥65 yrs, total cholesterol
levels ≥5 mmol/L (185 mg/dL) and systolic blood pressure ≥140 mmHg
 Italian (low-risk) smoker women with age ≥65 yrs and systolic blood
pressure ≥150 mmHg, independent of total cholesterol levels
 German (high-risk) non-smoker women with age ≥65 yrs, total
cholesterol levels ≥5 mmol/L (185 mg/dL) and systolic blood pressure
≥150 mmHg
 Swedish (high-risk) smoker women with age 60-64 yrs, systolic blood
pressure ≥150 mmHg, independent of total cholesterol levels
 Polish (high-risk) smoker women with age ≥65 yrs, independent of
systolic blood pressure and total cholesterol levels.
-
Specific settings
No convincing data for clopidogrel use
- Low-dose aspirin may be considered in post-menopausal women on hormone
replacement therapy (the bleeding risk must be weighed)
- Low-dose aspirin may be considered in women with breast cancer undergoing
radiotherapy (the bleeding risk must be weighed)
Summary box 2. Suggestions on antiplatelet therapy for secondary cardiovascular prevention in non-diabetic women
Setting
In women with CHD
Suggestions
-
No gender-specific recommendations in patients with stable or unstable CHD
In women with non cardio-embolic Low-dose aspirin preferred; clopidogrel may be considered
stroke/TIA
CHD= coronary heart disease; TIA= transient ischemic attack
Summary box 3. Suggestions on antiplatelet therapy for cardiovascular prevention in women with diabetes mellitus
Setting
Suggestions
Primary prevention

Low-dose aspirin is indicated in women with type-1 diabetes and targetorgan damage (the bleeding risk must be weighted)

Low-dose aspirin may be considered in women with a risk of >1
cardiovascular events/100 patients-year (the bleeding risk must be
weighted)
- No convincing data for clopidogrel use
Secondary prevention
CHD= coronary heart disease
-
No gender-specific recommendations in patients with stable or unstable CHD
(low-dose aspirin preferred as single antiplatelet therapy)
Summary box 4. Suggestions on antiplatelet therapy in pregnant women
- Potential benefits of low-dose aspirin may warrant use despite
potential risks
- Low-dose aspirin may be considered in women at high risk of
early pre-eclampsia
- Clopidogrel: animal studies failed to demonstrate risks to the
fetus and in isolated clinical reports the general outcome was
favorable for both mother and fetus
- Prasugrel: animal studies failed to demonstrate risks to the fetus
and in isolated clinical reports the general outcome was
favorable for both mother and fetus
- Ticagrelor: indicated only if the potential benefits overcome the
potential deleterious effects to the fetus