Gender-based differences in platelet function and platelet reactivity to P2Y12 inhibitors

Area of Science:

• Cardiovascular Medicine
• Hematology
• Pharmacology

Background:

• Gender significantly influences platelet biology, with women typically exhibiting higher platelet counts.
• However, gender-based differences in platelet function remain a subject of ongoing research and debate.
• This study investigates these differences using point-of-care platelet function tests (PFT).

Purpose of the Study:

• To investigate gender-based differences in platelet function.
• To assess the impact of platelet count on platelet reactivity in men and women.
• To evaluate the clinical implications for antiplatelet therapy, particularly P2Y12 inhibitors.

Main Methods:

• A cohort of 760 cardiac surgery patients with preoperative PFT (multiple-electrode aggregometry [MEA]) was analyzed.
• Platelet count and function (ADPtest and TRAPtest) were compared between genders.
• Analysis was stratified based on the presence or absence of residual P2Y12 inhibitor effects.

Main Results:

• Women demonstrated a significantly higher platelet count (P = 0.001) and a trend towards higher ADP-induced platelet reactivity.
• In clopidogrel-treated patients, women exhibited significantly higher ADP reactivity (P = 0.031), with platelet count being the primary determinant.
• Women with high platelet counts (≥ 200,000 cells/μL) had a significantly higher rate of high-on-treatment platelet reactivity (HTPR) (45.5%) compared to men with lower counts (< 200,000 cells/μL) (11.9%).

Conclusions:

• Findings confirm higher platelet counts in women, associated with a trend towards increased platelet reactivity.
• High-on-treatment platelet reactivity (HTPR) is notably prevalent in women with elevated platelet counts.
• This suggests women on P2Y12 inhibitors may benefit from adjusted dosing or alternative antiplatelet agents with lower HTPR rates.