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History of Cancer is Associated with Increased Platelet Activity and Atherothrombosis in Patients with Peripheral Artery Disease

1NYU Grossman School of Medicine, New York, United States, 2Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, United States, 3Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, United States, 4NYU Langone Health, New York, United States, 5Division of Hematology and Medical Oncology, NYU Grossman School of Medicine, New York, United States, 6Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, United States, 7Department of Medicine, NYU Grossman School of Medicine, New York, United States, 8Center for the Prevention of Cardiovascular Disease, NYU Langone Health, New York, United States

Abstract Number: LPB0050

Meeting: ISTH 2021 Congress

Theme: Arterial Thromboembolism » Cardiovascular Risk Factors

Background: Cancer and peripheral artery disease (PAD) share common risk factors and are frequently coprevalent. Platelets are culprits in the pathogenesis of PAD and mediators of arterial cardiovascular events. The association between platelet activity and cardiovascular events in patients with versus without cancer is uncertain.

Aims: To investigate if cancer history is associated with platelet activity and incident cardiovascular events in a cohort of patients with PAD.

Methods: 289 patients with PAD undergoing lower extremity revascularization enrolled in the Platelet Activity and Cardiovascular Events (PACE) study were followed longitudinally for a median of 18 months. Prior to revascularization, patients had platelet activity measured via light transmission aggregometry in response to ADP, collagen, epinephrine, and serotonin. The primary clinical outcome was myocardial infarction (MI). Other endpoints were MI/stroke and major adverse cardiovascular event (MACE; MI/stroke/death).

Results: 64 patients (22.1%) reported a cancer history, 10 (15.6%) with metastatic and 10 (15.6%) with active cancer. Patients with (versus without) cancer history were older, less often Hispanic, and less frequently current smokers (P<0.05 for each). There was no difference in prevalent diabetes, coronary artery disease, hypertension, or antiplatelet therapy between groups. Platelet aggregation in response to submaximal ADP (0.4uM, 1.0uM), collagen (0.2 ug/ml, 1.0 ug/ml), and serotonin (10uM) was higher in patients with versus without cancer history. Consistently, patients with cancer history experienced more incident MI (18.8% vs. 7.6%, P=0.02), MI/stroke (25.0% vs. 9.3%, P=0.002), and MACE (35.9% vs. 22.2%, P=0.04). After adjustment for age, sex, race/ethnicity, smoking, diabetes, prior stroke, CAD, revascularization procedure, and antiplatelet therapy, patients with cancer history were at higher hazard for MI, MI/stroke, and MACE (Figure). The association between cancer and thrombotic events was most apparent in patients with metastatic and active cancer (Figure).

Adjusted hazard ratios for cardiovascular events by study group

Conclusions: In patients with PAD, cancer history was associated with increased platelet aggregation and risk for arterial thrombotic events.

To cite this abstract in AMA style:

Cofer L, Barrett T, Xia Y, Luttrell-Williams E, Myndzar K, Wong K-, Wise D, Berger J. History of Cancer is Associated with Increased Platelet Activity and Atherothrombosis in Patients with Peripheral Artery Disease [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/history-of-cancer-is-associated-with-increased-platelet-activity-and-atherothrombosis-in-patients-with-peripheral-artery-disease/. Accessed December 7, 2021.

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