As in men, aspirin allocation in primary prevention trials increased the risk of hemorrhagic stroke and major gastrointestinal and extracra- nial bleeds among women and resulted in uncertain net value. There is no evidence of a differential effect of antiplate- let agents for secondary stroke in women compared with The Antithrombotic Trialists meta-analysis of aspirin for the primary and secondary prevention of vascu- lar events (MI, stroke, vascular death) also included individual patient data from each of the trials.437 They found similar pro- portional reductions in risk for men and women for the com- bined outcome; however, there was a trend toward benefit for primary prevention in women versus men, although this was no longer the case when the P value was adjusted for multiple In secondary prevention (among patients who already have occlusive vascular disease), aspirin appears to result in a greater absolute benefit for stroke prevention, with similar magnitude of effect for women and men, and a 19% reduction in stroke risk.437 Strategies for Prevention of Stroke in Women: Summary and Gaps In all clinical trials of primary and secondary stroke pre- vention, women need to be included in sufficient numbers for preplanned subgroup analysis, with reasonable statisti- cal power to provide for valid analysis to test for sex inter- Questions about the benefits and risks of carotid procedures in women with asymptomatic high-grade carotid stenosis and symptomatic treatment for moderate (50% 69%) carotid stenosis remain unanswered. Until further studies are performed, the recommendations for prevention of stroke in women with carotid disease (symptomatic or asymptom- atic) remain the same as for men, as published in the primary and secondary prevention guidelines.19,20 For aspirin, the recommendations below for women are as published in the AHA s Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women. 