BACKGROUND AND AIMS: It is well known that elevated cholesterol is associated with enhanced platelet aggregation and patients suffering from familial hypercholesterolemia (FH) have a high risk of thrombotic cardiovascular events. Although decreasing cholesterol level is associated with attenuation of platelet hyperactivity, there are currently no data on the effect of convertase subtilisin/kexin type 9 monoclonal antibodies (PCSK9ab) on platelet reactivity in FH. The aim of the study was to analyse the impact of different therapies including PCSK9ab on platelet aggregation in FH. METHODS: This study enrolled all 15 patients treated in the University Hospital Hradec Králové for FH. PCSK9ab have been administered in 12 of 15 patients while 8 patients were also undergoing lipid apheresis. Blood samples from all patients including pre- and post-apheresis period were tested for platelet aggregation triggered by 7 inducers, and the effect of 3 clinically used drugs (acetylsalicylic acid, ticagrelor and vorapaxar) was compared as well. RESULTS: Although apheresis decreased the reactivity of platelets in general, platelet responses were not different between non-apheresis patients treated with PCSK9ab and apheresis patients (post-apheresis values) with the exception of ristocetin. However, when compared to age-matched healthy population, FH patients had significantly lower platelet aggregation responses to 4 out of 7 used inducers and higher profit from 2 out of 3 used antiplatelet drugs even after exclusion of FH patients regularly receiving conventional antiplatelet treatment. CONCLUSION: This study showed for the first time the suitability of PCSK9ab treatment for reduction of platelet reactivity in FH patients.

The 3rd Department of Internal Medicine Metabolic Care and Gerontology University Hospital and Faculty of Medicine in Hradec Králové Charles University 50005 Hradec Králové Czechia

The Department of Analytical Chemistry Faculty of Pharmacy in Hradec Králové Charles University 50005 Hradec Králové Czechia

The Department of Clinical Biochemistry and Diagnostics University Hospital Hradec Králové 50005 Hradec Králové Czechia

The Department of Pharmacognosy and Pharmaceutical Botany Faculty of Pharmacy in Hradec Králové Charles University 50005 Hradec Králové Czechia

The Department of Pharmacology and Toxicology Faculty of Pharmacy in Hradec Králové Charles University 50005 Hradec Králové Czechia

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