Clinical outcomes in women with PAD after revascularization procedures are worse as
compared to men, yet there is little in the existing literature as why this may be
the case. Platelet Mapping is an emerging point-of-care viscoelastic technology that
measures the comprehensive properties of a blood clot, including fibrin-platelet interactions.
This prospective observational study aimed to characterize the clinical and Platelet
Mapping profiles of female and male patients undergoing lower extremity revascularization,
and to correlate Platelet Mapping distribution to thrombotic potential.
All patients with a diagnosis of PAD undergoing named vessel open or endovascular
revascularization to reestablish either inflow, outflow, or both, during December
2020 and January 2022 were prospectively included. Patients were followed clinically
for thrombosis for up to one year. Platelet Mapping assays were performed in three
clinical phases: preoperative, postoperative inpatient and postoperative outpatient.
Inferential analysis between female and male patient was performed. The quartile distribution
of Platelet Mapping metrics associated with thrombosis was used to infer to thrombotic
One hundred and seven patients were enrolled, of which thirty-seven (34.6%) were female.
Female patients had significantly lower rates of uncontrolled diabetes [2.7% vs. 18.6%],
hypertension requiring combination therapy [37.8% vs. 58.6%], CKD [27.0% vs. 51.4%],
CAD [29.7% vs. 57.1%] and MI [16.2% vs. 35.7%], (all p<0.05). Platelet reactivity was significantly higher in female patients with greater platelet
aggregation [75.9±23.3 vs. 63.5±28.8] and lower platelet inhibition [23.8±23.4 vs.
36.8±28.9] (all p<0.01). This trend was consistent over time when stratified by the postoperative inpatient
and postoperative outpatient clinical phases. There was no statistically discernable
difference in the use of antiplatelet therapy between groups, yet female patients
continued to exhibit greater platelet reactivity when analyzed by type of pharmacologic
regimen [platelet aggregation on monoantiplatelet therapy: 80.6±21.0 in women vs.
69.4±25.0 in men; platelet aggregation on dual antiplatelet therapy: 67.9±23.8 in
women vs. 44.8±31.8 in men] (all p<0.01). 21 patients experienced postoperative graft/stent thrombosis within the study period.
In relation to the overall study population, patients with thrombosis had Platelet
Mapping metrics above the 50th percentile of overall platelet aggregation distribution.
There is a growing appreciation for the differences in etiology, disease progression
and outcomes of cardiovascular conditions as they relate to sex. In this cohort, traditional
cardiovascular risk factors were in lower prevalence in female patients. Platelet
reactivity was found to be higher across clinical phases and antiplatelet regimens.
High platelet reactivity was also associated with an increased incidence of thrombosis
after lower extremity revascuarlization. These hypothesis-generating findings provide
the basis for further exploration of sex-specific coagulation profiling in PAD patients.