Short-Term Exposure to Waterpipe/Hookah Smoke Triggers a Hyperactive Platelet Activation State and Increases the Risk of Thrombogenesis

Ahmed B. Alarabi, Zubair A. Karim, Jean E.Montes Ramirez, Keziah R. Hernandez, Patricia A. Lozano, José O. Rivera, Fatima Z. Alshbool, Fadi T. Khasawneh

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Objective: Cardiovascular disease is a major public health problem. Among cardiovascular disease's risk factors, tobacco smoking is considered the single most preventable cause of death, with thrombosis being the main mechanism of cardiovascular disease mortality in smokers. While tobacco smoking has been on the decline, the use of waterpipes/hookah has been rising, mainly due to the perception that they are less harmful than regular cigarettes. Strikingly, there are few studies on the negative effects of waterpipes on the cardiovascular system, and none regarding their direct contribution to thrombus formation. Approach and Results: We used a waterpipe whole-body exposure protocol that mimics real-life human exposure scenarios and investigated its effects, relative to clean air, on platelet function, hemostasis, and thrombogenesis. We found that waterpipe smoke (WPS)-exposed mice exhibited both shortened thrombus occlusion and bleeding times. Further, our results show that platelets from WPS-exposed mice are hyperactive, with enhanced agonist-induced aggregation, dense and α-granule secretion, αIIbβ3 integrin activation, phosphatidylserine expression, and platelet spreading, when compared with clean air-exposed platelets. Finally, at the molecular level, it was found that Akt (protein kinase B) and ERK (extracellular signal-regulated kinases) phosphorylation are enhanced in the WPS and in nicotine-Treated platelets. Conclusions: Our findings demonstrate that WPS exposure directly modulates hemostasis and increases the risk of thrombosis and that this is mediated, in part, via a state of platelet hyperactivity. The negative health impact of WPS/hookah, therefore, should not be underestimated. Moreover, this study should also help in raising public awareness of the toxic effects of waterpipe/hookah.

Original languageEnglish (US)
Pages (from-to)335-349
Number of pages15
JournalArteriosclerosis, thrombosis, and vascular biology
Issue number2
StatePublished - Feb 1 2020
Externally publishedYes


  • hookah
  • platelets
  • smokers
  • thrombosis
  • tobacco smoking
  • waterpipe

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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