Aims To study sex differences in major bleeding in relation to dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). Methods and results The Collective Cardiology Research registry was designed to evaluate the application and outcomes of DAPT after ACS/PCI in the Rijnmond region in the Netherlands. Overall, 1172 women (median age 67.5 years) and 3087 men (62.2 years) with ACS/PCI were enrolled between August 2011 and June 2013. Based on a tailored regional DAPT guideline aiming at bleeding risk minimization, 52.6% women and 66.9% men received prasugrel as first-choice P2Y12 inhibitor, additional to aspirin. Women more frequently had contraindications for the use of prasugrel (and therefore received clopidogrel) than men (47.9 vs. 26.9%, p<0.001). Femoral access was more common in women than in men (47.6 vs. 38.1%, p<0.001). Women had higher incidence of TIMI major bleeding at 1 year than men (2.6 vs. 1.6%, p=0.018). After adjustment for established bleeding risk factors, female sex was associated with over two-fold higher risk of TIMI major bleeding (adjusted hazard ratio 2.33; 95% confidence interval 1.26 to 4.32). This difference was already apparent at discharge, and appeared to be caused by access site bleedings (0.9 vs. 0.1%, p<0.001). No sex differences were found in non-access site related TIMI major bleeding up to 1 year. Conclusion Women with ACS/PCI receiving DAPT had higher TIMI major bleeding risk caused by an excess in access-site bleeds, mainly in relation to the femoral approach.


中文翻译：

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接受阿司匹林和 P2Y12 抑制剂双重抗血小板治疗的急性冠脉综合征患者的性别相关出血风险。

目的 研究急性冠脉综合征 (ACS) 经皮冠状动脉介入治疗 (PCI) 后大出血与双联抗血小板治疗 (DAPT) 相关的性别差异。方法和结果 集体心脏病学研究注册中心旨在评估荷兰 Rijnmond 地区 ACS/PCI 后 DAPT 的应用和结果。总体而言，2011 年 8 月至 2013 年 6 月期间，有 1172 名女性（中位年龄 67.5 岁）和 3087 名男性（62.2 岁）接受了 ACS/PCI。根据旨在最大程度降低出血风险的定制区域 DAPT 指南，其中 52.6% 为女性，66.9% 为男性除阿司匹林外，普拉格雷作为首选 P2Y12 抑制剂。女性比男性更常有使用普拉格雷的禁忌症（因此接受氯吡格雷治疗）（47.9% vs. 26.9%，p<0.001）。股动脉入路在女性中比男性更常见（47.6% vs. 38.1%，p<0.001）。女性 1 年 TIMI 大出血发生率高于男性（2.6% vs. 1.6%，p=0.018）。对已确定的出血风险因素进行调整后，女性与 TIMI 大出血风险高出两倍以上相关（调整后的风险比为 2.33；95% 置信区间为 1.26 至 4.32）。这种差异在出院时就已经很明显，并且似乎是由入路部位出血引起的（0.9% vs. 0.1%，p<0.001）。长达 1 年的非通路部位相关 TIMI 大出血未发现性别差异。结论 接受 DAPT 的 ACS/PCI 女性因入路部位出血过多而导致 TIMI 大出血风险较高，主要与股骨入路有关。