Clin Res Cardiol (2022).

Overweight is associated with an increased platelet reactivity despite dual antiplatelet therapy with aspirin and clopidogrel
M. Puccini1, C. Rauch1, K. Jakobs1, J. Friebel1, A. Hassanein1, U. Landmesser1, U. Rauch-Kröhnert1
1CC 11: Med. Klinik für Kardiologie, Charité - Universitätsmedizin Berlin, Berlin;

Purpose: Obese patients exhibit an overall increased platelet reactivity and a reduced sensitivity to antiplatelet therapy. The aim of this study is to evaluate the platelet reactivity measured by impedance aggregometry in patients with overweight and obesity and chronic coronary syndrome (CCS) that were treated with dual antiplatelet therapy (DAPT).  

Methods: Platelet aggregation was assessed by impedance aggregometry in patients with CCS receiving DAPT (aspirin plus clopidogrel). We compared the platelet reactivity in patients with a normal weight versus the patients with overweight or obesity. Furthermore, the correlation between the body mass index (BMI) and adenosine diphosphate (ADP-) or thrombin receptor activating peptide (TRAP-) dependent platelet aggregation was analyzed.

Results: 64 patients were included in the study of which 35,9 % were patients with normal weight. A higher ADP- and TRAP- dependent platelet reactivity was observed in overweight and obese patients (ADP: median 27 Units (U) [IQR 13-39,5] vs. 7 U [6-15], p<0,001 and TRAP: 97 U [73-118,5] vs. 85 U [36 -103], p=0,035). Positive significant correlations were observed between agonist-induced platelet reactivity and BMI.

Conclusion: Despite the use of DAPT, a higher platelet reactivity was found in overweight and obese patients with CCS. If these patients will benefit from treatment with more potent platelet inhibitors needs to be evaluated in future clinical trials.

Fig. 1 Platelet aggregation measured by impedance aggregometry in patients with BMI 18,5 - 25 kg/m² (n = 23) and BMI ≥ 25 kg/m² (n = 41) and Spearman´s correlation between platelet reactivity and BMI. A. ADP indicates the ADP-induced platelet reactivity and TRAP the thrombin induced platelet reactivity; B. Correlation between ADP-induced platelet reactivity as a function of the body mass index (r = 0,643, p < 0,001); C. Correlation between thrombin-induced platelet reactivity as a function of the body mass index (r = 0,453, p < 0,001)