Grant: Travel Awards - Institute Community Support

Antiplatelet medications are important in managing heart disease caused by plaque buildup. Female bodies metabolize medications differently compared to males, and biological sex and sex steroid hormones may influence platelet activity. Yet, the clinical guidelines used by physicians take a one-size-fits-all approach. We assessed female representation in the antiplatelet medication literature, informing the 2023 Canadian Antiplatelet Guidelines. Literature cited in the 2023 Canadian Antiplatelet Guidelines was systematically reviewed. Experimental and observational research and systematic reviews were included. Extracted data included study titles, author, year, design, sample size, mean participant age and proportion of females. Of 138 unique citations, 118 were included. Most studies were published in the last decade (64%), less than one-third between 2004 and 2014 (30%) and few before 2004 (6%). The total sample size was 834,934 (28.7% female), with a mean age of 65.4 years. To assess female representation, we calculated participation-to-prevalence ratios (PPR). The PPR is a measure of the representation of a specific group in a study population relative to the prevalence in the disease population. Of the included studies, only 25 (21%) had adequate female representation (PPR of 0.8 to 1.2); females were underrepresented in 84 (73%) (PPR less than 0.8), and females were overrepresented in 6 (6%) (PPR greater than 1.2). Females were not adequately represented in nearly two-thirds of the evidence. The 2023 guidelines are primarily informed by evidence, which only had adequate male representation or overrepresentation. There remains a need for greater attention to adequately representing females in clinical trials for anti-platelet medications. Having the ability to look at sex-stratified data would provide clinicians the opportunity to choose medications based on trial evidence.