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Beyond solely estrogen: Sex-based differences in platelet biology and antithrombotic response

Heart Science Journal · Vol. 7 No. 2 (2026) · pp. 36–42

DOI
10.21776/ub.hsj.2026.007.02.6
ISSN
2721-9984, 2721-9976
Published
2026-04-26
Publisher
Universitas Brawijaya
Language
en
License
creativecommons.org/licenses/by/4.0

Abstract

Despite increased awareness of sex differences in cardiovascular disease (CVD), disparities in sex-specific platelet biology and antithrombotic studies are still underexplored. Moreover, women are frequently underrepresented in clinical trials, with numerous research initiatives primarily focusing on estrogen while neglecting non-hormonal influences that contribute variations in thrombotic risk and treatment outcomes. We conducted a literature review to examine sex-related differences in platelet biology, such as elevated platelet counts and reactivity in females, along with distinct expression of receptors and signaling molecules. These variations influence responses to antiplatelet medications—including aspirin, P2Y12 inhibitors, and glycoprotein IIb/IIIa inhibitors, and dual antiplatelet therapy—leading to altered effectiveness and a heightened bleeding risk in women. This review emphasizes the importance of non-hormonal factors, such as transcriptomic and proteomic variations, and highlights the growing potential of omics and systems biology in identifying therapeutic targets specific to sex. Incorporating sex as a biological factor in preclinical and clinical research is crucial for enhancing risk assessment and treatment results.

Keywords

Collaboration network of the authors

32 authors · 160 co-authorship links

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  • Universitas Muhammadiyah Gorontalo
  • Universitas Airlangga
  • Universitas Nurul Jadid
  • Taipei Medical University
  • Affiliation unknown
  • Different organisations
  • Same organisation
  • Affiliation unknown
  • Thicker line = more joint articles · bigger circle = more articles
Show as table
Co-authorOrganisationJoint articles
Nathanael Jonathan TjiptaAffiliation unknown2
Chaq El Chaq Zamzam MultazamAffiliation unknown2
Melita Amalia AyubaAffiliation unknown2
Mochamad YusufAffiliation unknown2
Gwenny Ichsan PrabowoAffiliation unknown2
Bayu Satria WiratamaTaipei Medical University2
Soetjipto SoetjiptoAffiliation unknown2
Langgeng Agung WaskitoAffiliation unknown2
Clarissa ElvarettaAffiliation unknown2
Dian Eka Roro PalupiAffiliation unknown2
Ema QurnianingsihAffiliation unknown2
Lina LukitasariAffiliation unknown2
Ira HumairahAffiliation unknown2
Siti KhaerunnisaAffiliation unknown2
Retno HandajaniAffiliation unknown2
Indri SafitriAffiliation unknown2
Fithriyah Cholifatul UmmahAffiliation unknown2
Indah Binti Mohd AminAffiliation unknown2
Syahrial SyahrialUniversitas Muhammadiyah Gorontalo1
Eryc PranataAffiliation unknown1
Alfian Nur RosyidUniversitas Airlangga1
David Setyo BudiAffiliation unknown1
Ifan Ali WafaAffiliation unknown1
Nando Reza PratamaAffiliation unknown1
Henry SutantoAffiliation unknown1
Ahmad ZubaidiUniversitas Nurul Jadid1
Su RitohardoyoAffiliation unknown1

Affiliations come from OpenAlex; journal OAI-PMH metadata carries none. Authors without an OpenAlex ID are matched by name, which can merge or split people.

Metadata source: OAI-PMH (metadata jurnal) https://heartscience.ub.ac.id/index.php/heartscience/oai, first harvested 8 Nov 2026, last seen 8 Nov 2026.
Original metadata (oai_dc) 
<oai_dc:dc xmlns="http://www.openarchives.org/OAI/2.0/" xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/  http://www.openarchives.org/OAI/2.0/oai_dc.xsd">
	<dc:title xml:lang="en">Beyond solely estrogen: Sex-based differences in platelet biology and antithrombotic response</dc:title>
	<dc:creator xml:lang="en">Salma, Zaskia Nafisa</dc:creator>
	<dc:creator xml:lang="en">Susilo, Hendri</dc:creator>
	<dc:creator xml:lang="en">Wungu, Citrawati Dyah Kencono</dc:creator>
	<dc:creator xml:lang="en">Tandecxi, Gabriel</dc:creator>
	<dc:creator xml:lang="en">Nugrahani, Annisa Salsabilla Dwi</dc:creator>
	<dc:subject xml:lang="en">platelet</dc:subject>
	<dc:subject xml:lang="en">sex difference</dc:subject>
	<dc:subject xml:lang="en">antithrombotic therapy</dc:subject>
	<dc:subject xml:lang="en">cardiovascular disease</dc:subject>
	<dc:description xml:lang="en">Despite increased awareness of sex differences in cardiovascular disease (CVD), disparities in sex-specific platelet biology and antithrombotic studies are still underexplored. Moreover, women are frequently underrepresented in clinical trials, with numerous research initiatives primarily focusing on estrogen while neglecting non-hormonal influences that contribute variations in thrombotic risk and treatment outcomes.
We conducted a literature review to examine sex-related differences in platelet biology, such as elevated platelet counts and reactivity in females, along with distinct expression of receptors and signaling molecules. These variations influence responses to antiplatelet medications—including aspirin, P2Y12 inhibitors, and glycoprotein IIb/IIIa inhibitors, and dual antiplatelet therapy—leading to altered effectiveness and a heightened bleeding risk in women. This review emphasizes the importance of non-hormonal factors, such as transcriptomic and proteomic variations, and highlights the growing potential of omics and systems biology in identifying therapeutic targets specific to sex. Incorporating sex as a biological factor in preclinical and clinical research is crucial for enhancing risk assessment and treatment results.</dc:description>
	<dc:publisher xml:lang="en">Universitas Brawijaya</dc:publisher>
	<dc:date>2026-04-26</dc:date>
	<dc:type>info:eu-repo/semantics/article</dc:type>
	<dc:type>info:eu-repo/semantics/publishedVersion</dc:type>
	<dc:format>application/pdf</dc:format>
	<dc:identifier>https://heartscience.ub.ac.id/index.php/heartscience/article/view/20569</dc:identifier>
	<dc:identifier>10.21776/ub.hsj.2026.007.02.6</dc:identifier>
	<dc:source xml:lang="en">Heart Science Journal; Vol. 7 No. 2 (2026): The Evolving Landscape of Heart Failure; 36-42</dc:source>
	<dc:source>2721-9984</dc:source>
	<dc:source>2721-9976</dc:source>
	<dc:source>10.21776/ub.hsj.2026.007.02</dc:source>
	<dc:language>en</dc:language>
	<dc:relation>https://heartscience.ub.ac.id/index.php/heartscience/article/view/20569/577</dc:relation>
	<dc:rights xml:lang="en">Copyright (c) 2026 Zaskia Nafisa Salma, Hendri Susilo, Citrawati Dyah Kencono Wungu, Gabriel Tandecxi, Annisa Salsabilla Dwi Nugrahani</dc:rights>
	<dc:rights xml:lang="en">http://creativecommons.org/licenses/by/4.0</dc:rights>
</oai_dc:dc>