Sex Differences in Outcomes After Transcatheter Aortic Valve Replacement

Unequal Treatment and Yentl Syndrome

“…Previous studies revealed that various issues arise in non-White patients when it comes to diagnosis and treatment of AS. 5 , 6 , 7 , 8 Although this study suggests nonsignificant primary outcomes between male and female patients (and between Asians and non-Asians) at 1 year, future research, including long-term analyses, will be instrumental in solidifying these insights. The possibility that sex and racial minorities may encounter other challenges during diagnosis, management, and final treatment for their AS still requires further investigation.…”

Sex discrepancies in pathophysiology, presentation, treatment, and outcomes of severe aortic stenosis

“…However, it is worth noting that female sex is associated with a higher incidence of major bleeding and major vascular access site complications ( 25 , 33 , 34 ). In a recently published post hoc analysis of the Antiplatelet Therapy for Patients Undergoing Transcatheter Aortic Valve Implantation (POPular TAVI) trial, the influence of sex on bleeding and ischemic complications following TAVI was examined, taking into account the specific antiplatelet and anticoagulation regimens used ( 35 ). This analysis showed that the overall incidence of bleeding events did not differ between women and men, but women exhibited a higher occurrence of major or life-threatening bleedings as compared to men.…”

“…An interesting observation of this study was the differential effect of antithrombotic treatment on bleeding events in women and men. Specifically, women who received aspirin both before and after TAVI had a higher incidence of major or life-threatening bleeding as compared to men ( 35 ). Several mechanisms have been suggested to account for post-TAVI bleeding, encompassing intrinsic bleeding abnormalities that go beyond the platelet system ( 36 ).…”

“…Since coexistence of epicardial coronary artery disease among patients with AS is common and both pathologies lead to similar symptoms, decisions making regarding treatment of either AS or coronary artery disease or both remains a challenge. This is particularly true since treatment for coronary artery disease will require dual antiplatelet therapy, increasing the risk of bleeding in women undergoing TAVI ( 35 ). Further clarification on which patients are more susceptible to bleeding after TAVI might arise from subanalyses of data derived from the Global Study Comparing a Rivaroxaban-based Antithrombotic Strategy to an Antiplatelet-based Strategy after Transcatheter Aortic Valve Replacement to Optimize Clinical Outcomes (GALILEO) ( 38 ).…”