Abstract
BackgroundGender influences platelet biology. Women have a larger platelet count, but gender-based differences in platelet function remain debated. We performed a study addressing gender-based differences in platelet function using point-of-care platelet function tests (PFT).MethodsThe patient population consisted of 760 cardiac surgery patients where preoperative PFT (multiple-electrode aggregometry [MEA]) were available. Platelet count and function at the ADPtest and TRAPtest were compared in the overall population and separately in patients with or without residual effects of P2Y12 inhibitors.ResultsWomen had a significantly (P = 0.001) higher platelet count but a non-significantly higher platelet reactivity to ADP. In clopidogrel-treated patients, the platelets ADP reactivity was significantly (P = 0.031) higher in women, and platelet count was the main determinant of platelet hyper-reactivity. Within patients under full clopidogrel effects, women with a platelet count ≥ 200,000 cells/μL had a significantly (P = 0.023) higher rate of high-on-treatment platelet reactivity (HTPR, 45.5%) with respect to males with a platelet count < 200,000 cells/μL (11.9%), with a relative risk of 6.2 (95% confidence interval 1.4–29).ConclusionsOur findings confirm that women have a larger platelet count than men, and that this is associated to a trend towards a higher platelet reactivity. HTPR is largely represented in women with a high platelet count. This generates the hypothesis that women requiring P2Y12 inhibitors could potentially benefit from larger doses of drug or should be treated with anti-platelet agents with a low rate of HTPR.
Highlights
Platelet biology is influenced by gender [1,2,3]
Within patients under full clopidogrel effects, women with a platelet count 200,000 cells/μL had a significantly (P = 0.023) higher rate of high-on-treatment platelet reactivity (HTPR, 45.5%) with respect to males with a platelet count < 200,000 cells/ μL (11.9%), with a relative risk of 6.2 (95% confidence interval 1.4–29)
Our findings confirm that women have a larger platelet count than men, and that this is associated to a trend towards a higher platelet reactivity
Summary
In patients under double anti-platelet therapy (DAPT) the interaction between gender and efficacy was absent [11, 12] or only demonstrated a trend towards a lower efficacy in women [13]. Most of the studies investigating gender-dependent differences in platelet function were based on platelet count only, obsolete tests (bleeding time), light-transmission aggregometry, optical aggregometry, or sophisticated laboratory tests. The recent randomized controlled trials investigating the efficacy of different P2Y12 inhibitors used point-of-care (POC) platelet function tests (PFT) to address platelet reactivity and high on-treatment platelet reactivity (HTPR) [14,15,16]. Women have a larger platelet count, but gender-based differences in platelet function remain debated. We performed a study addressing genderbased differences in platelet function using point-of-care platelet function tests (PFT)
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