Female Representation in the Antiplatelet Medication Literature Informing the 2023 Canadian Antiplatelet Guidelines.

Antiplatelet medications remain essential in managing atherosclerotic cardiovascular disease. We assessed the adequacy of female representation in the antiplatelet medication literature, which informed the 2023 Canadian Antiplatelet Guidelines. Literature cited in the 2023 Canadian Antiplatelet Guidelines was systematically reviewed. Randomized controlled trials were included. Observational studies, systematic reviews, guidelines, consensus documents, studies missing demographic data, and research protocols were excluded. Extracted data included study titles, author, year, design, sample size, mean participant age, and proportion of female participants. Of 138 identified unique citations, 109 studies met the inclusion criteria. From the included evidence informing the 7 antiplatelet PICO (population, intervention, comparison, outcome) topics, the total sample size was 570,217 participants, with a mean age of 65.4 years. The mean percentage of female participants included across trials was 28.5%, and 21% of the included studies had a participation-to-prevalence ratio of 0.8-1.2 for female participants. Female patients were not adequately represented in nearly two-thirds of the evidence informing antiplatelet medication trials. Thus, the 2023 Canadian Antiplatelet Guidelines PICO topics are informed largely by evidence with inadequate female representation. A need remains for greater attention to adequately representing female patients in clinical trials for antiplatelet medications, which in turn inform clinical guidelines.