Introduction: Peripheral artery disease (PAD) outcomes are worse in females as compared to males, yet females are notably under-represented in existing literature contributing to a substantial knowledge gap. Platelet Mapping (PM) is a novel viscoelastic technology that may provide integral insight. This prospective observational study characterized sex-based differences in PM profiles.

Methods: Patients undergoing revascularization during 12/20-1/22 underwent serial PM analysis, which was compared by sex. The quartile distribution of PM metrics associated with thrombosis was used to infer to thrombotic potential.

Results: 321 PM samples from 107 patients were analyzed, of which 34.1% were female. Female patients had significantly less uncontrolled diabetes [2.7%vs.18.6%], HTN [37.8%vs.58.6%], CKD [27.0%vs.51.4%], and CAD [29.7%vs.57.1%], (all p<0.05).

Antiplatelet-management was not significantly different between groups, yet female patients exhibited greater platelet aggregation compared to males- [monoantiplatelet-therapy: 80.6±21.0vs.69.4±25.0; dual antiplatelet-therapy: 67.9±23.8vs.44.8±31.8] (all p<0.01).

Platelet Mapping metrics associated with thrombotic events clustered in the upper quartiles of overall platelet aggregation distribution.

Conclusion: Female patients exhibited significantly lower traditional cardiometabolic risk factors, yet consistently greater platelet reactivity. PM metrics associated with thrombosis clustered in the upper (prothrombotic) quartiles of aggregation, suggesting this is potentially targetable health information. These novel findings challenge existing management paradigms for the female-PAD population.