Association of lipoprotein(a) with intrinsic and on-clopidogrel platelet reactivity

J Thromb Thrombolysis. 2022 Jan;53(1):1-9. doi: 10.1007/s11239-021-02515-2. Epub 2021 Jul 2.


Lipoprotein(a) [Lp(a)] is an independent, genetically determined, and causal risk factor for cardiovascular disease. Laboratory data have suggested an interaction of Lp(a) with platelet function, potentially caused by its interaction with platelet receptors. So far, the potential association of Lp(a) with platelet activation and reactivity has not been proven in larger clinical cohorts. This study analyzed intrinsic platelet reactivity before loading with clopidogrel 600 mg and on-treatment platelet reactivity tested 24 h following loading in patients undergoing elective coronary angiography. Platelet reactivity was tested by optical aggregometry following stimulation with collagen or adenosine diphosphate as well as by flow cytometry. Lp(a) levels were directly measured in all patients from fresh samples. The present analysis included 1912 patients. Lp(a) levels ranged between 0 and 332 mg/dl. There was a significant association of rising levels of Lp(a) with a higher prevalence of a history of ischemic heart disease (p < 0.001) and more extensive coronary artery disease (p = 0.001). Results for intrinsic (p = 0.80) and on-clopidogrel platelet reactivity (p = 0.81) did not differ between quartiles of Lp(a) levels. Flow cytometry analyses of expression of different platelet surface proteins (CD41, CD62P or PAC-1) confirmed these findings. Correlation analyses of levels of Lp(a) with any of the tested platelet activation markers did not show any correlation. The present data do not support the hypothesis of an interaction of Lp(a) with platelet reactivity.

Keywords: Coronary arterial disease; Dual antiplatelet therapy (DAPT); Lipoprotein(a); Percutaneous coronary intervention; Platelet reactivity; Riscfactor.

MeSH terms

  • Blood Platelets / metabolism
  • Clopidogrel / pharmacology
  • Humans
  • Lipoprotein(a)*
  • Percutaneous Coronary Intervention*
  • Platelet Aggregation
  • Platelet Aggregation Inhibitors / pharmacology
  • Platelet Aggregation Inhibitors / therapeutic use
  • Platelet Function Tests
  • Ticagrelor / pharmacology
  • Ticlopidine / therapeutic use


  • Lipoprotein(a)
  • Platelet Aggregation Inhibitors
  • Clopidogrel
  • Ticagrelor
  • Ticlopidine