Identifying Sex Dimorphism in Peripheral Artery Disease with Platelet Mapping

Majumdar, Monica; McElroy, Imani; Waller, Harold D.; Lella, Srihari; Hall, Ryan; Kirshkaln, Amanda; Feldman, Zach M.; Kim, Young; DeCarlo, Charles; Dua, Anahita

doi:10.1016/j.avsg.2022.08.006

Cited by 5 publications

(7 citation statements)

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“…This suggests that there may be inherent differences in platelet activation and inhibition specific to this group. 10 Building on previous research from our coagulation laboratory, we have recently shown that among patients with PAD undergoing revascularization, the increased platelet reactivity and decreased platelet inhibition was predictive of subacute postoperative graft/stent thrombosis, and also that women had higher platelet reactivity, with increased platelet aggregation and diminished platelet inhibition, despite the use of similar antiplatelet medication than men. 4,11 Another study has showed that overall, the use of dual antiplatelet therapy had greater platelet inhibition than the use of mono antiplatelet therapy.…”

Section: Discussionmentioning

confidence: 92%

“…10 Building on previous research from our coagulation laboratory, we have recently shown that among patients with PAD undergoing revascularization, the increased platelet reactivity and decreased platelet inhibition was predictive of subacute postoperative graft/stent thrombosis, and also that women had higher platelet reactivity, with increased platelet aggregation and diminished platelet inhibition, despite the use of similar antiplatelet medication than men. 4,11 Another study has showed that overall, the use of dual antiplatelet therapy had greater platelet inhibition than the use of mono antiplatelet therapy. 12 These findings reinforce the concept that it is important to acknowledge that mono antiplatelet therapy with aspirin may be sufficient to achieve an appropriate platelet inhibition in males but it might be necessary to add an additional antiplatelet medication to women, in order to avoid undesirable outcomes.…”

Section: Discussionmentioning

confidence: 92%

“…The limited data available on disease‐specific aspects in women present a paradox, mainly due to the absence of conventional cardiovascular risk factors in this population. The underrepresentation of women in existing PAD research leads to a knowledge gap in understanding the disease, resulting in delayed diagnosis, often due to asymptomatic or atypical presentations, consequently elevating their risk of unfavorable outcomes 1,4 . One of the aspects that might be related to these differences is women's platelet biology, platelet reactivity, and their response to antiplatelet medications 4 …”

Section: Introductionmentioning

confidence: 99%

“…The underrepresentation of women in existing PAD research leads to a knowledge gap in understanding the disease, resulting in delayed diagnosis, often due to asymptomatic or atypical presentations, consequently elevating their risk of unfavorable outcomes. 1,4 One of the aspects that might be related to these differences is women's platelet biology, platelet reactivity, and their response to antiplatelet medications. 4 Antiplatelet medications are the cornerstone of medical therapy for patients with PAD.…”

mentioning

confidence: 99%

“…1,4 One of the aspects that might be related to these differences is women's platelet biology, platelet reactivity, and their response to antiplatelet medications. 4 Antiplatelet medications are the cornerstone of medical therapy for patients with PAD. Aspirin is considered the "gold standard" agent for prevention of arterial thrombosis, mostly in patients after undergoing revascularization.…”

mentioning

confidence: 99%

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The impact of sex on platelet responses to aspirin in patients with peripheral artery disease

Suarez Ferreira,

Hall,

Morrow

et al. 2024

American J Hematol

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Women with peripheral artery disease (PAD) have poorer limb salvage outcomes in spite of having lower risk factors for vascular disease than their male counterparts. Mono antiplatelet therapy with aspirin is the cornerstone of medical treatment for PAD to reduce the risk of arterial thrombosis, but platelets in women may have a variable response to this standard of care compared to men. Viscoelastic assays, such as thromboelastography with platelet mapping (TEG‐PM), have been utilized to identify prothrombotic states and may provide insight into a patient's real‐time coagulation profile and their response to specific antiplatelet medications. The aim of this prospective, observational study was to delineate the sex differences in platelet function using TEG‐PM in patients with PAD on aspirin post‐revascularization for PAD. All patients with PAD undergoing revascularization on aspirin monotherapy were prospectively enrolled between December 2020 and September 2023. The cohort was divided by sex, demographics, medications, procedure type, and outcomes were documented. Serial perioperative TEG‐PM assays (1, 3, and 6 months) were performed up to 6 months postoperatively and platelet function was evaluated in both groups. Statistical analysis between women and men was performed to identify sex‐specific differences in platelet function. Over the study period, a total of 303 patients were enrolled. Of this cohort, 149 patients met the study criteria and 266 samples were analyzed; 52 (34.89%) were women and 97 (65.11%) were men. In the platelet mapping assay, women showed significantly greater MAActF and MAAA, than men (16.66 vs. 14.94, p < .03 and 37.26 vs. 32.38, p < .01, respectively) indicating stronger thrombotic propensity. Additionally, platelet inhibition was significantly lower in women compared to men (52.95% vs. 61.65%, p < .05). In clinical outcomes reported as thrombotic events, women showed significantly higher occlusion in the area of intervention than men (4 vs. 1, p < .05). There is a growing awareness of the variations in the natural course, underlying mechanisms, and resulting outcomes of cardiovascular conditions, including PAD, in relation to sex. In this study, women did not achieve the same levels of platelet inhibition and displayed a procoagulant tendency in comparison to men when administered aspirin. Overall, aspirin monotherapy may be potentially sufficient for men, but women may require increased doses and/or additional antiplatelet medications to achieve an equivalent therapeutic effect.

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Section: Discussionmentioning

confidence: 92%