Journal of Thrombosis and Thrombolysis

, Volume 48, Issue 3, pp 373–381 | Cite as

Gender differences in thrombogenicity among patients with angina and non-obstructive coronary artery disease

  • Rahul Chaudhary
  • Ajaypaul Sukhi
  • Rohit Chaudhary
  • Manila Jindal
  • Ankit Vyas
  • Amit Rout
  • Kevin Bliden
  • Udaya Tantry
  • Paul GurbelEmail author


Women more often present with angina and non-obstructive coronary artery disease (ANOCA) and have poorer clinical outcomes than men. These findings may be related to sex associated differences in inflammation and thrombogenicity. Consecutive patients (n = 134) with ANOCA (luminal diameter stenosis < 50%) undergoing elective cardiac catheterization were included in post hoc analysis of Multi-Analyte, thrombogenic, and Genetic Markers of Atherosclerosis (MAGMA, NCT01276678) study. Patients with prior revascularization, coronary artery bypass grafting or myocardial infarction were excluded. Blood for thromboelastography, oxidized LDL β2-glycoprotein complex (AtherOx), oxidized-LDL, lipid profile, and urine for 11-dehydrothromboxane B2 (dTxB2) were obtained before catheterization. All women (n = 75) were post-menopausal and tended to be older than men (61.4 ± 10.6 vs. 58.6 ± 9.9 year, p = 0.12), and were significantly more thrombogenic with higher thrombin-induced platelet–fibrin strength (TIP–FCS, mm) (68.0 ± 4.5 vs. 64.5 ± 6.2 mm, p = 0.001), clotting index (0.35 ± 2.22 vs. − 0.72 ± 2.75, p = 0.02), K (measure of the speed to reach 20 mm of clot strength from an amplitude of 2 mm) (2.2 ± 1.6 vs. 1.7 ± 0.5 min, p = 0.01), and fibrinogen activity (degrees) (66.6 ± 7.1 vs. 62.9 ± 7.5, p = 0.009). Markers of inflammation were not significantly different between the two groups. Women had higher total cholesterol, total LDL, LDL subtypes 1 and 2, total HDL, HDL subtypes 2 and 3, and ApoA1 (p < 0.05 for all). On multivariate regression, TIP–FCS remained significantly higher in women (p < 0.0001). Women with ANOCA are more thrombogenic than men. This fundamental difference in thrombogenicity may affect gender-related outcomes and warrants further investigation.


Non-obstructive CAD ANOCA Cardiovascular outcomes Coronary artery disease Thrombogenicity TEG 



This study was supported by a research grant from Sinai Hospital of Baltimore. Thromboelastography supplies were provided by Haemonetics® Corp. VAP© testing was provided by Atherotech® Inc. Urinary 11-dehydrothromboxane B2 and AtherOx testing were provided by Corgenix Medical Corp. We wish to acknowledge Tania Gesheff RN, MSN, Kiran Kalra, MBBS, and Cescelle Barbour RN, MSN for their contributions to this study.

Compliance with ethical standards

Conflicts of interest

Paul Gurbel reports serving as a consultant for Daiichi Sankyo/Lilly, Bayer, AstraZeneca, Accumetrics, Merck, Medtronic, Janssen, CSL, and Haemonetics; receiving grants from the National Institutes of Health, Daiichi Sankyo, Lilly, CSL, AstraZeneca, Haemetics, Harvard Clinical Research Institute, and Duke Clinical Research Institute; receiving payment for lectures, including service on speakers’ bureaus, from Lilly, Daiichi Sankyo, and Merck; receiving payment for development of educational presentations from Merck, the Discovery Channel, and Pri-Med; Dr. Gurbel is holding stock or stock options in Merck, Medtronic, and Pfizer; and holding patents in the area of personalized antiplatelet therapy and interventional cardiology. No other authors report any potential conflicts of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Rahul Chaudhary
    • 1
    • 2
    • 3
  • Ajaypaul Sukhi
    • 1
  • Rohit Chaudhary
    • 4
  • Manila Jindal
    • 5
  • Ankit Vyas
    • 5
  • Amit Rout
    • 1
  • Kevin Bliden
    • 5
  • Udaya Tantry
    • 6
  • Paul Gurbel
    • 7
    Email author
  1. 1.Sinai Hospital of BaltimoreBaltimoreUSA
  2. 2.Division of Hospital Internal MedicineMayo ClinicRochesterUSA
  3. 3.Indiana UniversityBloomingtonUSA
  4. 4.Peter Lee AssociatesSydneyAustralia
  5. 5.Inova Center for Thrombosis Research and Drug DevelopmentInova Heart and Vascular InstituteFairfaxUSA
  6. 6.Platelet and Thrombosis ResearchBaltimoreUSA
  7. 7.Interventional Cardiology and Cardiovascular Medicine Research, Inova Center for Thrombosis Research and Drug DevelopmentInova Heart and Vascular InstituteFalls ChurchUSA

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