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


Autoři: Marco Ranucci aff001;  Tommaso Aloisio aff001;  Umberto Di Dedda aff001;  Lorenzo Menicanti aff002;  Carlo de Vincentiis aff002;  Ekaterina Baryshnikova aff001
Působiště autorů: Department of Cardiothoracic, Vascular Anaesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy aff001;  Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan Italy aff002
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225771

Souhrn

Background

Gender 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).

Methods

The 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.

Results

Women 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).

Conclusions

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. 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.

Klíčová slova:

bilirubin – Body Mass Index – Cardiac surgery – Creatinine – Hematocrit – Obesity – Platelet aggregation – Platelets


Zdroje

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2019 Číslo 11