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Variability In Clot Strength In Women Of Different Racial Background
Vaishnavi Siripurapu, BS, Isabella Cieri, MD, Adriana Rodriguez, MD, Shiv Patel, BS, Anahita Dua, MD, MS, MBA, MSC.
Massachusetts General Hospital, Boston, MA, USA.
OBJECTIVES: Antiplatelet therapy is an integral aspect in managing peripheral arterial disease. However, the differences in therapeutic responses to antiplatelet therapy of historically underrepresented Black and Hispanic female patients have yet to be evaluated. This pilot study aims to explore the impacts of race and sex on the response to antiplatelet therapy.
METHODS: Patients with peripheral arterial disease undergoing endovascular revascularization were enrolled between 2021 and 2024. All patients received antiplatelet therapy post-revascularization, either mono antiplatelet therapy (MAPT) consisting of aspirin or clopidogrel or dual antiplatelet therapy (DAPT) consisting of aspirin and clopidogrel or aspirin and ticagrelor. Patients then underwent thromboelastography with platelet mapping (TEG-PM) assays to objectively evaluate real-time coagulation profiles. Patients were grouped by race and sex. Activator F Maximum Amplitude (ActFA-MA) values, an objective measure of blood viscoelasticity caused by fibrin network creation, were compared from Black/Hispanic female patients and white female patients. Data was then analyzed via descriptive statistics, paired t-tests, and two-way ANOVA testing.
RESULTS: A total of 19 patients were analyzed at the 1 month post procedure time point: 4 Black / Hispanic female patients and 6 white females on DAPT, 3 Black / Hispanic patients and 6 white females on MAPT. Unpaired t-test analysis revealed a significant difference (p<0.05) in AcTF-MA between white women (n=6) and black and Hispanic women (n=4) on DAPT. The average AcTF-MA value for white women was 12.13mm, and the average AcTF-MA value for black and Hispanic women was 25.75mm. Significant differences in the AcTF-MA were also observed (p<0.05) with an unpaired t-test between white women (n=9) and Black/Hispanic women (n=3) on MAPT. White female patients had a mean ActF-MA average value of 14.53mm compared to an average value of 25.66mm for Black and Hispanic female patients. A one-way ANOVA test comparing DAPT and MAPT between white female patients and black / Hispanic female patients also revealed a significant difference (p<0.01) in AcTF-MA values among White women and Black/Hispanic women.
CONCLUSIONS: The findings suggest that Black and Hispanic female patients have more hypercoagulable platelet profiles as compared to white female patients on the same medications. Tailored therapies considering race and sex may improve health outcomes. Future research exploring the underlying mechanisms driving disparities could help develop targeted interventions.
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