Comparison of Whole Blood Impedance Platelet Aggregation Using Adenosine Diphosphate and Arachidonic Acid Between Smokers and Non-Smokers
Whole Blood Impedance Platelet Aggregation Between Smokers and Non-Smokers
DOI:
https://doi.org/10.54393/pjhs.v7i9.3714Keywords:
Whole Blood Aggregometry, Impedance Aggregometry, Platelet Aggregation, Arachidonic Acid, Adenosine Diphosphate, Cigarette SmokingAbstract
Smoking enhances platelet aggregability and related ischemic and vascular events. However, data on whole blood impedance platelet aggregation in relation to both smoking duration and daily cigarette consumption separately in apparently healthy Pakistani adults are limited. Objective: To assess the association of smoking duration and number of cigarettes smoked daily with increased platelet aggregation and find out factors independently predicts increased aggregation. Methods: A comparative cross-sectional study was done at the Department of Pathology, Lahore General Hospital. Sixty-five smokers and non-smokers each (a total of 130) were enrolled using non-probability convenience sampling. History and venous samples were taken, and whole blood platelet aggregometry was performed using Arachidonic Acid and Adenosine diphosphate. Chi-Square and Logistic Regression tests were applied, p-value<0.050 was considered significant. Results: 84.6% of non-smokers had normal aggregation with both agonists. The percentage of individuals with enhanced aggregation increased as the duration of smoking and the number of daily cigarettes increased. Analysis showed a statistically significant association between abnormal aggregation and increased duration of smoking and number of daily cigarettes. Logistic Regression showed duration of smoking as an independent predictor of increased aggregation with ADP only (p-value=0.006, Exp(B)=15). The number of cigarettes smoked daily was not an independent predictor after adjusting for confounders. Results for age and hematocrit were not significant. Conclusions: Cigarette smoking is associated with increased platelet aggregation. Longer duration of smoking independently predicts high ADP-induced platelet aggregation after adjusting for age and hematocrit. The number of cigarettes smoked daily is not an independent predictor of increased aggregation.
References
Current Affairs. WHO Global Report on Trends in Prevalence of Tobacco Use 2000–2024. 2025 Oct. https://visionias.in/current-affairs/news-today/2025-10-07/society/who-global-report-on-trends-in-prevalence-of-tobacco-use-2000-2024.
United Nations. Global Prospectives Human Stories. WHO: Despite a Decline, Tobacco Still Hooks One in Five Adults Worldwide. 2025 Oct. https://news.un.org/en/story/2025/10/1166039.
Schwartz SM. Epidemiology of Cancer. Clinical Chemistry. 2024 Jan; 70(1): 140-9. doi: 10.1093/clinchem/hvad202. DOI: https://doi.org/10.1093/clinchem/hvad202
Benowitz NL and Liakoni E. Tobacco Use Disorder and Cardiovascular Health. Addiction. 2022 Apr; 117(4): 1128-38. doi: 10.1111/add.15703. DOI: https://doi.org/10.1111/add.15703
Fu M, Mei A, Min X, Yang H, Wu W, Zhong J et al. Advancements in Cardiovascular Disease Research Affected by Smoking. Reviews in Cardiovascular Medicine. 2024 Aug; 25(8): 298. doi: 10.31083/j.rcm2508298. DOI: https://doi.org/10.31083/j.rcm2508298
Otsu W, Ishida K, Chinen N, Nakamura S, Shimazawa M, Tsusaki H et al. Cigarette Smoke Extract and Heated Tobacco Products Promote Ferritin Cleavage and Iron Accumulation in Human Corneal Epithelial Cells. Scientific Reports. 2021 Sep; 11(1): 18555. doi: 10.1038/s41598-021-97956-3. DOI: https://doi.org/10.1038/s41598-021-97956-3
Hahad O, Kuntic M, Kuntic I, Daiber A, Münzel T. Tobacco Smoking and Vascular Biology and Function: Evidence from Human Studies. Pflügers Archiv-European Journal of Physiology. 2023 Jul; 475(7): 797-805. doi: 10.1007/s00424-023-02805-z. DOI: https://doi.org/10.1007/s00424-023-02805-z
Seo YS, Park JM, Kim JH, Lee MY. Cigarette Smoke-Induced Reactive Oxygen Species Formation: A Concise Review. Antioxidants. 2023 Sep; 12(9): 1732. doi: 10.3390/antiox12091732. DOI: https://doi.org/10.3390/antiox12091732
Wu X, Liu Y, Zou C, He F, Guo F, Liu S et al. Nicotine’s Impact on Platelet Function: Insights into Hemostasis Mechanisms. Frontiers in Pharmacology. 2025 Jan; 15: 1512142. doi: 10.3389/fphar.2024.1512142. DOI: https://doi.org/10.3389/fphar.2024.1512142
Loke WM, Sing KL, Lee CY, Chong WL, Chew SE, Huang H et al. Cyclooxygenase-1 Mediated Platelet Reactivity in Young Male Smokers. Clinical and Applied Thrombosis/Hemostasis. 2014 May; 20(4): 371-7. doi: 10.1177/1076029612466284. DOI: https://doi.org/10.1177/1076029612466284
Kholmukhamedov A. Platelet Reactivity in Dyslipidemia: Atherothrombotic Signaling and Therapeutic Implications. Reviews In Cardiovascular Medicine. 2021 Jan.
Platelet Function Testing: Impedance Platelet Aggregometry. 2022. https://www.practical-haemostasis.com/Platelets/platelet_function_testing_impedance_platelet_aggregometry.html
Kim HY. Statistical notes for clinical researchers: Sample size calculation 2. Comparison of two independent proportions. Restorative dentistry and endodontics. 2016 Apr;41(2):154. DOI: https://doi.org/10.5395/rde.2016.41.2.154
Sharma R, Kanaan M, Siddiqi K. The Diversity in Tobacco Use Among Women of Reproductive Age (15–49 Years) in Pakistan: A Secondary Analysis of a Multiple Indicator Cluster Survey 2016–2018. Nicotine and Tobacco Research. 2024 Jul; 26(7): 931-9. doi: 10.1093/ntr/ntae016. DOI: https://doi.org/10.1093/ntr/ntae016
Rawat A, Hivre M, Sharma A, Zaidi SA, Abedin MZ, Hasan MH. Smoking and Coronary Heart Disease Impact. Journal of Pharmaceutical Negative Results. 2023 Feb; 2023: 1737-42.
Ramotowski B, Undas A, Budaj A. Altered Platelet Reactivity, Coagulation, Endothelial and Inflammatory Markers Early After Smoking Cessation Verified with Cotinine Plasma Concentration. Journal of Thrombosis and Thrombolysis. 2023 Jul; 56(1): 75-81. doi: 10.1007/s11239-023-02819-5. DOI: https://doi.org/10.1007/s11239-023-02819-5
Parmar MP, Kaur M, Bhavanam S, Mulaka GS, Ishfaq L, Vempati R et al. A Systematic Review of the Effects of Smoking on the Cardiovascular System and General Health. Cureus. 2023 Apr; 15(4). doi: 10.7759/cureus.38073. DOI: https://doi.org/10.7759/cureus.38073
Kito Y, Iida M, Tanabe K, Onuma T, Tsujimoto M, Nagase K et al. Smoking Cessation Affects Human Platelet Activation Induced by Collagen. Experimental and Therapeutic Medicine. 2019 Nov; 18(5): 3809-16. doi: 10.3892/etm.2019.8025. DOI: https://doi.org/10.3892/etm.2019.8025
Inoue T, Hayashi M, Uchida T, Takayanagi K, Hayashi T, Morooka S. Significance of Platelet Aggregability Immediately After Blood Sampling and Effect of Cigarette Smoking. Platelets. 2001 Jan; 12(7): 415-8. doi: 10.1080/09537100120071068. DOI: https://doi.org/10.1080/09537100120071068
Metzen D, M'Pembele R, Zako S, Mourikis P, Helten C, Zikeli D et al. Platelet Reactivity Is Higher in E-Cigarette Vaping as Compared to Traditional Smoking. International Journal of Cardiology. 2021 Nov; 343: 146-8. doi: 10.1016/j.ijcard.2021.09.005. DOI: https://doi.org/10.1016/j.ijcard.2021.09.005
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