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Platelet, Antiplatelet Therapy and Metabolic Dysfunction-Associated Steatotic Liver Disease: A Narrative Review
Andrea Boccatonda1,2, Lorenza Del Cane3, Lara Marola3
1Internal Medicine, Bentivoglio Hospital, AUSL Bologna, 40010 Bentivoglio, Italy.
Abstract:
Metabolic dysfunction-associated steatotic liver disease (MASLD) is not only related to traditional cardiovascular risk factors like type 2 diabetes mellitus and obesity, but it is also an independent risk factor for the development of cardiovascular disease. MASLD has been shown to be independently related to endothelial dysfunction and atherosclerosis. MASLD is characterized by a chronic proinflammatory response that, in turn, may induce a prothrombotic state. Several mechanisms such as endothelial and platelet dysfunction, changes in the coagulative factors, lower fibrinolytic activity can contribute to induce the prothrombotic state. Platelets are players and addresses of metabolic dysregulation; obesity and insulin resistance are related to platelet hyperactivation. Furthermore, platelets can exert a direct effect on liver cells, particularly through the release of mediators from granules. Growing data in literature support the use of antiplatelet agent as a treatment for MASLD. The use of antiplatelets drugs seems to exert beneficial effects on hepatocellular carcinoma prevention in patients with MASLD, since platelets contribute to fibrosis progression and cancer development. This review aims to summarize the main data on the role of platelets in the pathogenesis of MASLD and its main complications such as cardiovascular events and the development of liver fibrosis. Furthermore, we will examine the role of antiplatelet therapy not only in the prevention and treatment of cardiovascular events but also as a possible anti-fibrotic and anti-tumor agent.
Insights
Metabolic dysfunction-associated steatotic liver disease (MASLD) involves platelets, increasing cardiovascular and liver disease risks. Antiplatelet agents may offer protective benefits against these MASLD complications.
Area of Science:
- Hepatology
- Cardiology
- Hematology
Background:
- Metabolic dysfunction-associated steatotic liver disease (MASLD) is linked to cardiovascular disease (CVD) risk factors like obesity and type 2 diabetes.
- MASLD independently contributes to endothelial dysfunction, atherosclerosis, and a prothrombotic state via chronic inflammation.
- Platelets are central to metabolic dysregulation, with obesity and insulin resistance promoting platelet hyperactivation.
Purpose of the Study:
- To review the role of platelets in MASLD pathogenesis.
- To explore platelet involvement in MASLD complications, including cardiovascular events and liver fibrosis.
- To examine the potential of antiplatelet therapy in managing MASLD and its sequelae.
Main Methods:
- Literature review of studies on platelet function in MASLD.
- Analysis of mechanisms linking platelets to endothelial dysfunction, atherosclerosis, and thrombosis.
- Evaluation of evidence for antiplatelet agents in MASLD-related cardiovascular events, fibrosis, and cancer.
Main Results:
- Platelets contribute to MASLD-related prothrombotic state through dysfunction and altered coagulation/fibrinolysis.
- Platelet hyperactivation is associated with obesity and insulin resistance in MASLD.
- Platelets influence liver fibrosis progression and hepatocellular carcinoma development in MASLD patients.
Conclusions:
- Platelets play a significant role in the pathogenesis and complications of MASLD.
- Antiplatelet therapy shows promise for preventing cardiovascular events in MASLD.
- Antiplatelet agents may offer therapeutic benefits against liver fibrosis and cancer in MASLD.
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