Postmenopausal women have an increased maximal platelet reactivity compared to men despite dual antiplatelet therapy

Dual antiplatelet medication with acetylsalicylic acid (ASA) and clopidogrel is the main therapy for patients with stable coronary vessel disease (CVD) after percutaneous coronary intervention (PCI). Despite platelet inhibition subgroups of patients have been shown to exhibit an increase of risk for adverse cardiovascular events. The aim of our study was to elucidate the influence of sex on platelet reactivity in patients with CVD under medication with ASA and clopidogrel. Two hundred and thirty patients with CVD on combined therapy with ASA (100 mg/day) and clopidogrel (75 mg/day) were included into our study. These patients were divided into a male (n = 128) and female (n = 102) group. Platelet reactivity was assessed by impedance aggregometry. Women demonstrated a significantly higher thrombin receptor-activating peptide (TRAP)-induced platelet reactivity than men (male 79.43 ± 28.55 U vs. female 89.3 ± 30.69 U; P 0.05) or arachidonic acid-induced (male 10.3 ± 12.87 U vs. female 12.76 ± 14.44 U; P > 0.05) platelet aggregation did not differ significantly between women and men. A multivariate linear regression model revealed female sex to be a significant prognostic marker for an increased TRAP-induced platelet reactivity, independent of the ASA and clopidogrel-associated platelet function inhibition. Sex differences did not influence the effectiveness of ASA or clopidogrel-mediated platelet function inhibition. Nevertheless, women had a significantly increased maximal platelet reactivity compared to men despite antiplatelet therapy.