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

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.

The effects of interval training on peripheral brain derived neurotrophic factor (BDNF) in young adults: a systematic review and meta-analysis

“…Additionally, as discussed previously, platelets store and release BDNF 71 , 72 . In this sense, classic and emerging studies show that women have higher platelet content than men 98 – 100 . In light of this, we do not discard that platelet count could contribute to a higher BDNF response in women compared with men (Table 2 ).…”

High Mean Platelet Volume Associates with In-Hospital Mortality in Severe Pneumonia Patients

“…The mechanism of this relationship is unclear, although sex differences in platelet function have been reported since 1975 [14]. Evidence demonstrated that compared to male patients, females have higher platelet counts and enhanced platelet activation [15,16,23,26], which may be potential reasons. As discussed, platelet plays a pivotal role in inflammation via a variety of pathways.…”

“…Besides, there is an important difference in platelet biology impacted by sex. It has been reported that the sexual diversity in platelet sensitivity may be intrinsic to the platelet [14], and females showed a higher platelet reactivity than males [15,16]. This feature suggests that the prognostic value of MPV in SP patients may be differed by sex.…”

Hydroxyvitamin D Serum Levels are Negatively Associated with Platelet Number in a Cohort of Subjects Affected by Overweight and Obesity

“…Our statistical analysis showed lower levels of platelets in men than in women and this result is in line with previous findings. The gender influence on platelet biology was shown several years ago [26] and recent studies reported a higher number of fibrinogen surface receptors and a greater ability to bind fibrinogen in women [27]. In addition, estrogens have been shown to enhance platelet production [28].…”