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Published on: June 5, 2019
Effect of gender difference on platelet reactivity
N J Breet1, M A Sluman, M A J P J van Berkel
1St Antonius Center for Platelet Function Research, St Antonius Hospital, Nieuwegein, the Netherlands.
Insights
Women showed higher platelet reactivity on antiplatelet therapy, but this did not lead to worse clinical outcomes. This suggests gender differences in platelet reactivity may not explain disparities in cardiovascular event risk.
Area of Science:
- Cardiology
- Pharmacology
- Hematology
Background:
- Previous research indicates potential gender disparities in antiplatelet medication efficacy.
- The underlying physiological mechanisms and clinical significance of this gender gap remain unclear.
Purpose of the Study:
- To investigate gender differences in on-treatment platelet reactivity.
- To determine if these differences impact clinical outcomes in patients undergoing coronary stent implantation.
Main Methods:
- Assessed on-treatment platelet reactivity in 717 men and 234 women using light transmittance aggregometry (LTA) and VerifyNow assays.
- Evaluated the incidence of major adverse cardiovascular events, including death, myocardial infarction, stent thrombosis, and stroke.
Main Results:
- Women had higher baseline platelet counts and greater on-clopidogrel platelet reactivity compared to men.
- On-aspirin platelet reactivity showed mixed results between the two assays used.
- Despite higher reactivity, the incidence of clinical endpoints was similar between genders.
Conclusions:
- While women exhibit higher platelet reactivity on dual antiplatelet therapy, the difference is small.
- The study suggests that increased platelet reactivity in women does not translate to a higher risk of adverse cardiovascular events.
- Gender-related differences in platelet reactivity are unlikely to be the sole cause of worse prognosis in women.
Background:
Previous studies have suggested that women do not accrue equal therapeutic benefit from antiplatelet medication as compared with men. The physiological mechanism and clinical implications behind this gender disparity have yet to be established.
Methods:
On-treatment platelet reactivity was determined in 717 men and 234 women on dual antiplatelet therapy, undergoing elective coronary stent implantation. Platelet function testing was performed using arachidonic acid and adenosine diphosphate-induced light transmittance aggregometry (LTA) and the VerifyNow P2Y12 and Aspirin assays. Also the incidence of all-cause death, non-fatal acute myocardial infarction, stent thrombosis and ischaemic stroke was evaluated.
Results:
Women had higher baseline platelet counts than men. Women exhibited a higher magnitude of on-aspirin platelet reactivity using LTA, but not using the VerifyNow Aspirin assay. The magnitude of on-clopidogrel platelet reactivity was significantly higher in women as compared with men with both tests used. The cut-off value to identify patients at risk as well as the incidence of clinical endpoints was similar between women and men (16/234[6.8%] vs. 62/717[8.6%], p = 0.38).
Conclusion:
Although the magnitude of platelet reactivity was higher in women, the absolute difference between genders was small and both the cut-off value to identify patients at risk and the incidence of the composite endpoint were similar between genders. Thus, it is unlikely that the difference in platelet reactivity accounts for a worse prognosis in women.
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