Among patients who experience bleeding complications after coronary stenting, women face 28% higher mortalitycompared to men who bleed. The disparity applies to death rates among those who experience bleeding complications.
The antiplatelet protocols your cardiologist follows were validated in trials where women comprised just one-quarter of participants. When bleeding occurs in women, the standard response protocols may not account for sex-specific physiology. Preventable deaths follow.
Among patients who experience bleeding after coronary stenting, women face 28% higher mortality compared to men—a disparity driven by protocols validated predominantly in male participants.
Start with the baseline numbers. Women who undergo coronary stenting face more than double the bleeding risk of men: 3.9% versus 1.8% in large registry analyses. A 2024 meta-analysis of 22 trials involving 99,591 patients found that one year after coronary intervention, women had 13% higher bleeding risk compared to men. Thousands of excess complications occur annually.
| Bleeding Risk Comparison | Women | Men | Disparity |
|---|---|---|---|
| Overall bleeding rate | 3.9% | 1.8% | 2.2× higher in women |
| One-year bleeding risk | 13% higher than men | Baseline | — |
| Mortality when bleeding occurs | 28% higher than men | Baseline | — |
Women who receive stents through radial artery access—the wrist approach that dramatically reduces bleeding compared to femoral access through the groin—still experience similar bleeding rates to men who undergo the higher-risk femoral approach. The safer access route in women produces the same bleeding risk as the riskier route in men.
Protocols Built on Male Physiology
After stenting, patients receive dual antiplatelet therapy: aspirin combined with drugs like clopidogrel, prasugrel, or ticagrelor. These medications prevent blood clots from forming on the new stent. The dosing, duration, and monitoring protocols come from clinical trials.
Those trials enrolled predominantly men. The 2024 meta-analysis found only 25.2% female participants across major stenting trials. A systematic review of 1,079 cardiovascular trials found the median female-to-male ratio was just 32% in acute coronary syndrome studies. Current guidelines acknowledge that:
"There are insufficient and inconsistent data on the effect of antiplatelet drugs in women"
Sex-specific dosing modifications do not exist.
Women show higher clot strength and increased platelet aggregation in response to standard antiplatelet therapy compared to men. The same medication dose may provide less clot protection in female physiology. Because women represented only one-quarter of trial participants, we lack the statistical power to validate different approaches.
Women need more aggressive clot prevention due to higher baseline risk. Standard antiplatelet regimens may be less effective in female physiology. We cannot recommend modifications because the evidence base is too thin.
Radial Access: Proven Benefit, Persistent Underuse
Australian registry data showed that radial access reduced major bleeding more dramatically in women (74% reduction) than in men (46% reduction). Only 41.6% of women received radial access compared to 51.0% of men. Female sex independently predicted lower likelihood of radial use even after adjusting for clinical factors.
One of the few interventions with clear sex-specific benefit remains underutilized in the population that would benefit most.
What This Means for You
When your cardiologist recommends coronary stenting with standard antiplatelet therapy, that protocol was validated in trials where three-quarters of participants were men. The bleeding risk estimates, medication dosing, and follow-up protocols reflect predominantly male outcomes data.
A 2024 analysis found no significant improvement in women's participation in cardiovascular trials from 2017 to 2024. Until trials achieve representative enrollment, women undergoing coronary intervention will continue navigating care with protocols that were not fully validated for their physiology.
Your cardiologist will likely not mention these statistics unless you ask. The 28% mortality gap exists partly because treatment conversations rarely acknowledge sex-specific risks. Radial access works dramatically better in women for bleeding prevention, but remains underutilized precisely where it matters most. The conversation framework that follows gives you language to change this dynamic in your own care.