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Postmenopausal women have an increased maximal platelet reactivity compared to men despite dual antiplatelet therapy

Peter Bobbert1, Caroline Stellbaum, Daniel Steffens

  • 1Department of Cardiology and Pneumology, Diabetes and Nutrition, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm, Berlin, Germany.

Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis
|November 9, 2012
PubMed

Insights

Women exhibit higher platelet reactivity than men despite dual antiplatelet therapy with acetylsalicylic acid (ASA) and clopidogrel. This sex difference in platelet response, particularly to thrombin receptor-activating peptide (TRAP), persists independently of standard antiplatelet medication.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacology
  • Hematology

Background:

  • Dual antiplatelet therapy (DAPT) with aspirin (ASA) and clopidogrel is standard for stable coronary vessel disease (CVD) post-percutaneous coronary intervention (PCI).
  • Subgroups of patients on DAPT show increased risk for adverse cardiovascular events, suggesting variability in treatment response.
  • The influence of sex on platelet reactivity and DAPT effectiveness requires further investigation.

Purpose of the Study:

  • To investigate the impact of sex on platelet reactivity in patients with CVD undergoing combined ASA and clopidogrel therapy.
  • To determine if sex influences the efficacy of ASA and clopidogrel in inhibiting platelet function.
  • To identify sex as a potential prognostic marker for cardiovascular events in patients on DAPT.

Main Methods:

  • A cohort of 230 patients with CVD on DAPT (ASA 100 mg/day, clopidogrel 75 mg/day) was divided into male (n=128) and female (n=102) groups.
  • Platelet reactivity was assessed using impedance aggregometry.
  • Multivariate linear regression analysis was employed to identify independent predictors of platelet reactivity.

Main Results:

  • Women showed significantly higher thrombin receptor-activating peptide (TRAP)-induced platelet reactivity compared to men (89.3 ± 30.69 U vs. 79.43 ± 28.55 U; P < 0.05).
  • No significant differences in adenosine diphosphate (ADP)- or arachidonic acid-induced platelet aggregation were observed between sexes.
  • Female sex was identified as a significant independent predictor of increased TRAP-induced platelet reactivity.

Conclusions:

  • Women exhibit higher maximal platelet reactivity than men, even when treated with ASA and clopidogrel.
  • Sex differences do not appear to affect the inhibitory efficacy of ASA or clopidogrel on platelet function.
  • Increased TRAP-induced platelet reactivity in women warrants further research regarding its clinical implications for cardiovascular event risk.

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