Cardiovascular disease is the leading cause of disability and mortality among women in the United States. However, relative to their representation among the overall population of patients presenting with acute coronary syndromes, women have been underrepresented in clinical trials of treatment strategies for acute coronary syndromes. In general, subgroup analyses and meta-analyses of the data from the major treatment trials have demonstrated similar treatment effects among women and men, but questions recently have been raised regarding the role and effect of antiplatelet therapy in the treatment of women. This article will review the use of antiplatelet therapy in women from the perspective of both primary and secondary prevention using as a focus for discussion recent randomized clinical trial data and registry observations of the potential benefits and risks of antiplatelet therapy in women.