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Gender Differences in Platelet Reactivity in Patients Receiving Dual Antiplatelet Therapy

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Abstract

Background

Cardiovascular risk is still underestimated in women, experiencing higher mortality and worse prognosis after acute cardiovascular events. Gender differences have been reported in thrombotic and hemorrhagic risk during dual antiplatelet therapy (DAPT), thus suggesting a potential variability in platelet reactivity according to sex. The aim of the present study was to assess the role of gender on platelet function and the prevalence of high-on treatment residual platelet reactivity (HRPR) during DAPT in patients with recent acute coronary syndrome or percutaneous coronary revascularization.

Methods

Patients treated with DAPT (ASA and clopidogrel or ticagrelor) were scheduled for platelet function assessment at 30–90 days post-discharge. By whole blood impedance aggregometry, HRPR was considered for ASPI test >862 AU*min (for ASA) and ADP test values ≥417 AU*min (for ADP-antagonists).

Results

We included 541 patients on DAPT, 122 (22.6 %) of whom were females. Females were older (p < 0.001), displayed more frequently hypercholesterolemia (p = 0.003), renal failure (p = 0.04), acute presentation (p < 0.001), higher cholesterol levels and platelets count (p < 0.001). Inverse association was demonstrated with smoking (p < 0.001), previous PCI (p = 0.04) and statin use (p = 0.03), creatinine and haemoglobin (p < 0.001). Female gender did not influence mean platelet reactivity or the prevalence of HRPR for ASA (1.7 % vs 1.4 %, OR[95%CI] = 1.14[0.17–4.36], p = 0.99, adjusted OR[95%CI] = 1.54[0.20–11.6], p = 0.68) or ADP-antagonists (26.3 % vs 22.8 %, OR[95%CI] = 1.17[0.52–1.34], p = 0.45, adjusted OR[95%CI] = 1.05[0.59–1.86], p = 0.87). Results did not change when considering separately the 309 patients treated with clopidogrel (34 % vs 31.3 %, OR[95%CI] = 1.13[0.62–2.07], p = 0.76, adjusted OR[95%CI] = 1.35[0.63–2.9], p = 0.44 for females vs males), or patients (n = 232) on ticagrelor (20.4 % vs 11.1 %, OR[95%CI] = 2.27[0.99–5.17], p = 0.06 for females vs males), confirmed after correction for baseline differences (adjusted OR[95%CI] = 1.21[0.28–2.29], p = 0.68).

Conclusion

In patients receiving dual antiplatelet therapy, gender does not impact on the prevalence of high-on treatment residual platelet reactivity (HRPR) with the major antiplatelet agents ASA, clopidogrel or ticagrelor.

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Authors’ Contribution

Monica Verdoia, MD

1) Conception and design; 2) Data collection; 3) Interpretation of the data; 4) Drafting of the article; 5) Final approval of the manuscript.

Lucia Barbieri, MD, Matteo Nardin,Veronica Daffara, MD

1) Interpretation of the data; 2) Data Collection; 3) Critical revision of the article for important intellectual content of the article; 4) Final approval of the manuscript.

Giorgio Bellomo, MD, Patrizia Pergolini, MD, Roberta Rolla, MD, Paolo Marino, MD

1) Interpretation of the data; 2) Critical revision of the article for important intellectual content of the article; 3) Final approval of the manuscript.

Harry Suryapranata, MD, PhD

1) Interpretation of the data; 2) Critical revision of the article for important intellectual content of the article; 3) Evaluation of platelet reactivity; 4)Final approval of the manuscript.

Giuseppe De Luca, MD, PhD

1) Conception and design; 2) Statistical analysis; 3) Interpretation of the data; 4) Drafting of the article; 5) Final approval of the manuscript; 6) Supervision.

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Authors and Affiliations

  1. Department of Cardiology, Ospedale “Maggiore della Carità”, Eastern Piedmont University, C.so Mazzini, 18, 28100, Novara, Italy

    Monica Verdoia, Matteo Nardin, Lucia Barbieri, Veronica Daffara, Paolo Marino & Giuseppe De Luca

  2. Clinical Chemistry, Ospedale “Maggiore della Carità”, Eastern Piedmont University, Novara, Italy

    Patrizia Pergolini, Roberta Rolla & Giorgio Bellomo

  3. Cardiology, UMC St Radboud, Nijmegen, The Netherlands

    Harry Suryapranata

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Verdoia, M., Pergolini, P., Rolla, R. et al. Gender Differences in Platelet Reactivity in Patients Receiving Dual Antiplatelet Therapy. Cardiovasc Drugs Ther 30, 143–150 (2016). https://doi.org/10.1007/s10557-016-6646-5

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