Gender Differences in Platelet Reactivity in Diabetic Patients Receiving Dual Antiplatelet Therapy.
Adenosine
Aftercare
Aspirin
Blood Platelets
Diabetes Mellitus
/ drug therapy
Drug Therapy, Combination
Female
Humans
Male
Patient Discharge
Percutaneous Coronary Intervention
Platelet Aggregation
/ drug effects
Platelet Aggregation Inhibitors
/ therapeutic use
Platelet Function Tests
Sex Characteristics
Ticlopidine
Diabetes mellitus
Dual antiplatelet therapy
Gender
Platelet aggregation
Journal
Cardiovascular revascularization medicine : including molecular interventions
ISSN: 1878-0938
Titre abrégé: Cardiovasc Revasc Med
Pays: United States
ID NLM: 101238551
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
received:
12
11
2019
revised:
02
02
2020
accepted:
07
02
2020
pubmed:
23
2
2020
medline:
15
7
2021
entrez:
23
2
2020
Statut:
ppublish
Résumé
Increased comorbidities and a perceived high-bleeding risk often prevent the use of dual antiplatelet therapy (DAPT) in female patients. However, more aggressive antiplatelet treatment would certainly offer additional outcome benefits in coronary artery disease, especially among diabetic patients. The aim of the present study was to evaluate the gender differences in high-residual on treatment platelet reactivity (HRPR) among diabetic patients treated with DAPT. Our population is represented by a consecutive cohort of diabetic patients treated with DAPT (ASA + clopidogrel, ticagrelor or dose-adjusted prasugrel) for an acute coronary syndrome or elective PCI, undergoing platelet reactivity assessment at 30-90 days post-discharge. Aggregation was assessed by multiple-electrode aggregometry and in diabetic patients naïve to antiplatelet therapy, by light transmission aggregometry, surface expression of P-selectin and plasma concentration of Thromboxane B2. We included 472 patients, 113 (23.9%) women. Female gender was associated with more advanced age, and increased comorbidities. Mean platelet reactivity did not differ according to gender. The rate of HRPR was similar in women as compared to men (for ASA: adjusted OR[95%CI] = 0.59[0.27-1.33], p = 0.21, for ADP-antagonists: adjusted OR[95%CI] = 1.24[0.25-1.80], p = 0.27), however, the benefits of the new ADP-antagonists on platelet reactivity were lower in women than in men (p interaction = 0.01). No impact of gender on platelet reactivity was confirmed among 50 diabetic patients naïve to antiplatelet therapy. Among diabetic patients receiving dual antiplatelet therapy gender does not affect platelet reactivity or high-on treatment platelet reactivity. However, the enhanced platelet inhibition provided by the new-ADP antagonists of new-ADP antagonists could be mitigated in women.
Sections du résumé
BACKGROUND
Increased comorbidities and a perceived high-bleeding risk often prevent the use of dual antiplatelet therapy (DAPT) in female patients. However, more aggressive antiplatelet treatment would certainly offer additional outcome benefits in coronary artery disease, especially among diabetic patients. The aim of the present study was to evaluate the gender differences in high-residual on treatment platelet reactivity (HRPR) among diabetic patients treated with DAPT.
METHODS
Our population is represented by a consecutive cohort of diabetic patients treated with DAPT (ASA + clopidogrel, ticagrelor or dose-adjusted prasugrel) for an acute coronary syndrome or elective PCI, undergoing platelet reactivity assessment at 30-90 days post-discharge. Aggregation was assessed by multiple-electrode aggregometry and in diabetic patients naïve to antiplatelet therapy, by light transmission aggregometry, surface expression of P-selectin and plasma concentration of Thromboxane B2.
RESULTS
We included 472 patients, 113 (23.9%) women. Female gender was associated with more advanced age, and increased comorbidities. Mean platelet reactivity did not differ according to gender. The rate of HRPR was similar in women as compared to men (for ASA: adjusted OR[95%CI] = 0.59[0.27-1.33], p = 0.21, for ADP-antagonists: adjusted OR[95%CI] = 1.24[0.25-1.80], p = 0.27), however, the benefits of the new ADP-antagonists on platelet reactivity were lower in women than in men (p interaction = 0.01). No impact of gender on platelet reactivity was confirmed among 50 diabetic patients naïve to antiplatelet therapy.
CONCLUSIONS
Among diabetic patients receiving dual antiplatelet therapy gender does not affect platelet reactivity or high-on treatment platelet reactivity. However, the enhanced platelet inhibition provided by the new-ADP antagonists of new-ADP antagonists could be mitigated in women.
Identifiants
pubmed: 32085942
pii: S1553-8389(20)30077-4
doi: 10.1016/j.carrev.2020.02.007
pii:
doi:
Substances chimiques
Platelet Aggregation Inhibitors
0
Adenosine
K72T3FS567
Ticlopidine
OM90ZUW7M1
Aspirin
R16CO5Y76E
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1144-1149Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.