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Regan IE, Cox D, Kelleher ST, Nolan B, Shaw K, Smith OP, McMahon CJ. Towards a greater understanding of reduced response to aspirin in children with congenital heart disease post-cardiac surgery using immature platelet fraction. Thromb Res 2024; 233:101-108. [PMID: 38039722 DOI: 10.1016/j.thromres.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/10/2023] [Accepted: 11/13/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE A high platelet turnover rate may produce a population of platelets that confers an inadequate response to aspirin. We aimed to investigate the relationship between residual platelet aggregation and platelet turnover in paediatric cardiology patients on aspirin monotherapy by evaluating the fraction of immature platelets as a marker for turnover and secondly to test the predictive value of the immature platelet fraction (IPF) to classify patients as responsive or non-responsive to aspirin. METHODS Sixty patients divided into two age categories (≤90 days, >90 days of age) were included in this prospective observational study. Patients were then stratified into tertiles using their IPF level. Platelet studies included thromboelastography with platelet mapping (TEGPM). RESULTS The overall incidence of 'inadequate response to aspirin' was 38 % in our patient cohort recently post-cardiac surgery a consequence that warrants further study. The frequency of inadequate response to aspirin was higher in the upper tertile of IPF when compared to the lower tertile, (88 %) versus (4 %) respectively (p < 0.05). The 'cut off' for IPF was determined to be 3.9 % with a sensitivity of 95.7 %, and a specificity of 92.9 % (area under the curve of 0.955 [CI 0.896-1.014, p < 0.05]). CONCLUSION This study demonstrates that inadequate response to aspirin occurs in approximately 38 % of patients undergoing specific high-risk congenital cardiac procedures using the dosing practice of a national centre. This study supports the hypothesis that an elevated platelet turnover may result in aspirin being less effective in patients who are recently post cardiac surgery. These data are of direct translational relevance.
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Affiliation(s)
- Irene E Regan
- Department of Coagulation/Haematology, Children's Health Ireland at Crumlin, Dublin, Ireland; School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland; National Children's Research Centre, Children's Health Ireland, Dublin, Ireland
| | - Dermot Cox
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Sean T Kelleher
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Beatrice Nolan
- Department of Coagulation/Haematology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Kathryn Shaw
- Department of Paediatric Pharmacy, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Owen P Smith
- Department of Coagulation/Haematology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Colin J McMahon
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland; School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland; School of Health Professions Education (SHE), Maastricht University, Maastricht, Netherlands; National Children's Research Centre, Children's Health Ireland, Dublin, Ireland.
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2
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Roguin N, Dahan S, Reiner-Benaim A, Laish-Farkash A, Yahud E, Kogan Y, Vasilenko L, Lev EI, Ben-Assa E. Correlation between baseline immature platelets fraction levels and peak troponin in patients with acute myocardial infarction. Coron Artery Dis 2024; 35:44-49. [PMID: 37990534 DOI: 10.1097/mca.0000000000001302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
INTRODUCTION Elevated peak cardiac troponin levels have been linked with increased morbidity and mortality in patients with acute myocardial infarction (AMI). Immature Platelets are young and relatively large platelets that are hyper-reactive and pro-thrombotic compared to regular platelets. Increased immature platelet fraction (IPF) has been associated with an elevated risk of thrombotic events. We hypothesize that patients with higher IPF levels during AMI, will experience a more severe infarct, leading to elevated peak troponin levels. METHODS Clinical data from patients admitted to the cardiology division between 2018 and 2022, who were diagnosed with AMI and underwent an IPF testing. Univariate and multivariate regression analyses were performed to identify predictors of elevated peak troponin. RESULTS Among the 277 patients diagnosed with AMI who underwent IPF testing, 113 had (STEMI) and 164 had (NSTEMI). The median value of IPF of 4.2% was used as the threshold for defining elevated IPF. Notably, among STEMI patients, those with IPF ≥ 4.2% had significantly higher peak troponin levels ( P = 0.021). Conversely, no significant difference in peak troponin levels was observed among NSTEMI patients ( P = 0.348). Multivariate analysis identified patients with STEMI in the higher IPF group as one of the significant predictors for elevated peak troponin levels. CONCLUSION This study revealed a correlation between higher baseline IPF levels and increased peak troponin levels specifically in STEMI patients, while no such association was found in NSTEMI patients. Incorporating IPF levels above the median into risk stratification scores for STEMI patients may provide valuable support for adopting a more proactive therapeutic approach.
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Affiliation(s)
- Nir Roguin
- Ben-Gurion University of the Negev, Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Beer Sheva
| | - Shani Dahan
- Cardiology Division, Assuta Ashdod University Hospital, Ben-Gurion University of the Negev, Ashdod
| | - Anat Reiner-Benaim
- Department of Epidemiology, Biostatistics and Community Health Sciences, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Avishag Laish-Farkash
- Cardiology Division, Assuta Ashdod University Hospital, Ben-Gurion University of the Negev, Ashdod
| | - Ella Yahud
- Cardiology Division, Assuta Ashdod University Hospital, Ben-Gurion University of the Negev, Ashdod
| | - Yonatan Kogan
- Cardiology Division, Assuta Ashdod University Hospital, Ben-Gurion University of the Negev, Ashdod
| | - Luba Vasilenko
- Cardiology Division, Assuta Ashdod University Hospital, Ben-Gurion University of the Negev, Ashdod
| | - Eli I Lev
- Cardiology Division, Assuta Ashdod University Hospital, Ben-Gurion University of the Negev, Ashdod
| | - Eyal Ben-Assa
- Cardiology Division, Assuta Ashdod University Hospital, Ben-Gurion University of the Negev, Ashdod
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Mariethoz C, Scala E, Matthey-Guirao E, Rossel JB, Gomez FJ, Grandoni F, Marcucci C, Alberio L. Identification of High Platelet Reactivity Despite ADP P2Y 12 Inhibitor Treatment: Two Populations in the Vasodilator-Stimulated Phosphoprotein Assay and Variable PFA-P2Y Shapes of Curve. TH OPEN 2023; 7:e143-e154. [PMID: 37292433 PMCID: PMC10247305 DOI: 10.1055/a-2075-7979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 04/03/2023] [Indexed: 06/10/2023] Open
Abstract
Introduction Response to ADP P2Y 12 receptor inhibition by clopidogrel can be evaluated by various techniques. Here, we compared a functional rapid point-of-care technique (PFA-P2Y) with the degree of biochemical inhibition assessed by the VASP/P2Y 12 assay. Methods Platelet response to clopidogrel was investigated in 173 patients undergoing elective intracerebral stenting (derivation cohort n = 117; validation cohort n = 56). High platelet reactivity (HPR) was defined as PFA-P2Y occlusion time <106 seconds or VASP/P2Y 12 platelet reactivity index (PRI) >50%. Results In the derivation cohort, receiver operator characteristics analysis for the ability of PFA-P2Y to detect biochemical HPR showed high specificity (98.4%) but poor sensitivity (20.0%) and a very low area under the curve (0.59). The VASP/P2Y 12 assay revealed two coexisting platelet populations with different levels of vasodilator-stimulated phosphoprotein (VASP) phosphorylation: a fraction of highly phosphorylated, inhibited platelets and another of poorly phosphorylated, reactive platelets. Analysis of the PFA-P2Y curve shape revealed different types, categorized by time of occlusion (<106 seconds, 106 to 300 seconds, >300 seconds), and pattern (regular, irregular, and atypical). Noteworthy, curves with late occlusion and permeable curves with an irregular or atypical pattern correlated with VASP-PRI >50% and smaller sizes of the inhibited platelet subpopulation. Considering the PFA-P2Y shape of the curve for the detection of HPR improved sensitivity (72.7%) and preserved specificity (91.9%), with a rather high AUC (0.823). The validation cohort confirmed the VASP/P2Y 12 assay data and the usefulness of considering the PFA-P2Y curve shape. Conclusion In patients treated with acetylsalicylic acid and clopidogrel for 7-10 days, the VASP/P2Y 12 assay reveals two coexisting subpopulations of differentially inhibited platelets, whose relative sizes predict global PRI and distinct PFA-P2Y curve patterns, indicating incomplete clopidogrel efficacy. The detailed analysis of both VASP/P2Y 12 and PFA-P2Y is necessary for optimal detection of HPR.
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Affiliation(s)
- Cyril Mariethoz
- Faculty of Biology and Medicine, UNIL, University of Lausanne, Lausanne, Switzerland
| | - Emmanuelle Scala
- Dept. of Anaesthesiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Elena Matthey-Guirao
- Division of Haematology and Central Haematology Laboratory, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Jean-Benoît Rossel
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Francisco Javier Gomez
- Division of Haematology and Central Haematology Laboratory, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Francesco Grandoni
- Division of Haematology and Central Haematology Laboratory, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Carlo Marcucci
- Faculty of Biology and Medicine, UNIL, University of Lausanne, Lausanne, Switzerland
- Dept. of Anaesthesiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Lorenzo Alberio
- Faculty of Biology and Medicine, UNIL, University of Lausanne, Lausanne, Switzerland
- Division of Haematology and Central Haematology Laboratory, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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4
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Bongiovanni D, Schreiner N, Gosetti R, Mayer K, Angiolillo DJ, Sibbing D, Holdenrieder S, Anetsberger A, von Scheidt M, Schunkert H, Laugwitz KL, Schüpke S, Kastrati A, Fegers-Wustrow I, Bernlochner I. Immature Platelet Fraction Predicts Adverse Events in Patients With Acute Coronary Syndrome: the ISAR-REACT 5 Reticulated Platelet Substudy. Arterioscler Thromb Vasc Biol 2023; 43:e83-e93. [PMID: 36546322 DOI: 10.1161/atvbaha.122.318614] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Immature or reticulated platelets are associated with impaired efficacy of antiplatelet drugs and adverse events in cardiovascular patients. Their role as a predictive biomarker in patients with acute coronary syndrome treated with potent P2Y12 receptor inhibitors is not fully understood. We aimed to prospectively evaluate reticulated platelets as a predictor of the primary end point of the ISAR-REACT 5 trial consisting of death, myocardial infarction, or stroke at 1 year in patients with acute coronary syndrome randomized to prasugrel or ticagrelor. METHODS Immature platelet fraction (IPF) was assessed within 48 hours after randomization. Patients were divided based on the IPF median values: the IPFhigh group included patients with IPF>median and the IPFlow group included patients with IPF≤median. Platelet aggregation was assessed using the Multiplate Analyzer and was correlated to IPF. RESULTS Five hundred seventy-seven patients were included in the study. IPF values in % (median [interquartile range]) within the first 48 hours did not differ between the two study groups: 3.6 (2.5-5.2)% in the prasugrel group and 3.6 (2.5-5.4)% in the ticagrelor group (P=0.882). The incidence of the primary end point was significantly higher in the IPFhigh (IPF>3.6%) group compared with the IPFlow (IPF≤3.6%) group: 13.0% versus 7.2% (HRadj, 1.74 [1.02-3.00]; P=0.044), independently from the assigned drug (Pint=0.159). No significant association between IPF and BARC 3 to 5 bleeding was observed. ADP-induced platelet aggregation correlated significantly with IPF in patients treated with prasugrel (r=0.22; P=0.005) while no correlation was detected in patients treated with ticagrelor (r=0.09; P=0.257). CONCLUSIONS Independently from drug treatment, IPF was associated with the primary end point and therefore is a promising biomarker for the prediction of adverse cardiovascular events in patients with acute coronary syndrome treated with prasugrel or ticagrelor. REGISTRATION https://www. CLINICALTRIALS gov; Unique identifier: NCT01944800.
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Affiliation(s)
- Dario Bongiovanni
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar (D.B., N.S., R.G., K.-L.L., I.F.-W., I.B.), Technical University of Munich, Germany.,Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland (D.B.).,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany (D.B., D.S., M.v.S., H.S., K.-L.L., S.S., A.K., I.B.).,Department of Cardiovascular Medicine, Humanitas Clinical and Research Center IRCCS and Humanitas University, Rozzano, Milan, Italy (D.B.)
| | - Nina Schreiner
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar (D.B., N.S., R.G., K.-L.L., I.F.-W., I.B.), Technical University of Munich, Germany
| | - Rosanna Gosetti
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar (D.B., N.S., R.G., K.-L.L., I.F.-W., I.B.), Technical University of Munich, Germany
| | - Katharina Mayer
- Department of Cardiology, Deutsches Herzzentrum München (K.M., M.v.S., H.S., S.S., A.K.), Technical University of Munich, Germany
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville (D.J.A.)
| | - Dirk Sibbing
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany (D.B., D.S., M.v.S., H.S., K.-L.L., S.S., A.K., I.B.).,Klinik der Universität München, Ludwig - Maximilians - University, Cardiology, Munich, Germany (D.S.)
| | - Stefan Holdenrieder
- Deutsches Herzzentrum München, Institute for Laboratory Medicine, Technische Universität München, Munich, Germany (S.H.)
| | - Aida Anetsberger
- Department of Anesthesiology, School of Medicine, University hospital rechts der Isar (A.A.), Technical University of Munich, Germany.,University of Applied Sciences Landshut, Faculty of Interdisciplinary Studies, Germany (A.A.)
| | - Moritz von Scheidt
- Department of Cardiology, Deutsches Herzzentrum München (K.M., M.v.S., H.S., S.S., A.K.), Technical University of Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany (D.B., D.S., M.v.S., H.S., K.-L.L., S.S., A.K., I.B.)
| | - Heribert Schunkert
- Department of Cardiology, Deutsches Herzzentrum München (K.M., M.v.S., H.S., S.S., A.K.), Technical University of Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany (D.B., D.S., M.v.S., H.S., K.-L.L., S.S., A.K., I.B.)
| | - Karl-Ludwig Laugwitz
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar (D.B., N.S., R.G., K.-L.L., I.F.-W., I.B.), Technical University of Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany (D.B., D.S., M.v.S., H.S., K.-L.L., S.S., A.K., I.B.)
| | - Stefanie Schüpke
- Department of Cardiology, Deutsches Herzzentrum München (K.M., M.v.S., H.S., S.S., A.K.), Technical University of Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany (D.B., D.S., M.v.S., H.S., K.-L.L., S.S., A.K., I.B.)
| | - Adnan Kastrati
- Department of Cardiology, Deutsches Herzzentrum München (K.M., M.v.S., H.S., S.S., A.K.), Technical University of Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany (D.B., D.S., M.v.S., H.S., K.-L.L., S.S., A.K., I.B.)
| | - Isabel Fegers-Wustrow
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar (D.B., N.S., R.G., K.-L.L., I.F.-W., I.B.), Technical University of Munich, Germany
| | - Isabell Bernlochner
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar (D.B., N.S., R.G., K.-L.L., I.F.-W., I.B.), Technical University of Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany (D.B., D.S., M.v.S., H.S., K.-L.L., S.S., A.K., I.B.)
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5
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Goudswaard LJ, Corbin LJ, Burley KL, Mumford A, Akbari P, Soranzo N, Butterworth AS, Watkins NA, Pournaras DJ, Harris J, Timpson NJ, Hers I. Higher body mass index raises immature platelet count: potential contribution to obesity-related thrombosis. Platelets 2022; 33:869-878. [PMID: 35068290 DOI: 10.1080/09537104.2021.2003317] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/08/2021] [Accepted: 10/21/2021] [Indexed: 02/02/2023]
Abstract
Higher body mass index (BMI) is a risk factor for thrombosis. Platelets are essential for hemostasis but contribute to thrombosis when activated pathologically. We hypothesized that higher BMI leads to changes in platelet characteristics, thereby increasing thrombotic risk. The effect of BMI on platelet traits (measured by Sysmex) was explored in 33 388 UK blood donors (INTERVAL study). Linear regression showed that higher BMI was positively associated with greater plateletcrit (PCT), platelet count (PLT), immature platelet count (IPC), and side fluorescence (SFL, a measure of mRNA content used to derive IPC). Mendelian randomization (MR), applied to estimate a causal effect with BMI proxied by a genetic risk score, provided causal estimates for a positive effect of BMI on both SFL and IPC, but there was little evidence for a causal effect of BMI on PCT or PLT. Follow-up analyses explored the functional relevance of platelet characteristics in a pre-operative cardiac cohort (COPTIC). Linear regression provided observational evidence for a positive association between IPC and agonist-induced whole blood platelet aggregation. Results indicate that higher BMI raises the number of immature platelets, which is associated with greater whole blood platelet aggregation in a cardiac cohort. Higher IPC could therefore contribute to obesity-related thrombosis.
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Affiliation(s)
- Lucy J Goudswaard
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
- Bristol Heart Institute, Bristol, UK
- Medical Research Council (MRC) Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Laura J Corbin
- Medical Research Council (MRC) Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kate L Burley
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - Andrew Mumford
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Parsa Akbari
- Department of Public Health and Primary Care, British Heart Foundation Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, UK
- National Institute for Health Research Blood and Transplant Research Unit (NIHR BTRU) in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
- Human Genetics, Wellcome Sanger Institute, Hinxton, UK
| | - Nicole Soranzo
- National Institute for Health Research Blood and Transplant Research Unit (NIHR BTRU) in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- Human Genetics, Wellcome Sanger Institute, Hinxton, UK
- Department of Haematology, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Adam S Butterworth
- Department of Public Health and Primary Care, British Heart Foundation Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, UK
- National Institute for Health Research Blood and Transplant Research Unit (NIHR BTRU) in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre, University of Cambridge and Cambridge University Hospitals, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
| | | | - Dimitri J Pournaras
- Department of Bariatric and Metabolic Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Jessica Harris
- Bristol Trials Centre, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Nicholas J Timpson
- Medical Research Council (MRC) Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ingeborg Hers
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
- Bristol Heart Institute, Bristol, UK
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6
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Bongiovanni D, Han J, Klug M, Kirmes K, Viggiani G, von Scheidt M, Schreiner N, Condorelli G, Laugwitz KL, Bernlochner I. Role of Reticulated Platelets in Cardiovascular Disease. Arterioscler Thromb Vasc Biol 2022; 42:527-539. [PMID: 35321562 DOI: 10.1161/atvbaha.121.316244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Human platelets differ considerably with regard to their size, RNA content and thrombogenicity. Reticulated platelets (RPs) are young, hyper-reactive platelets that are newly released from the bone marrow. They are larger and contain more RNA compared to older platelets. In comparison to more mature platelets, they exhibit a significantly higher thrombogenicity and are known to be elevated in patients with an increased platelet turnover such as, diabetics and after acute myocardial infarction. Several studies have shown that RPs correlate with an insufficient antiplatelet response to aspirin and specific P2Y12 receptor inhibitors. In addition, RPs are promising novel biomarkers for the prediction of adverse cardiovascular events in cardiovascular disease. However, the reason for RPs intrinsic hyper-reactivity and their association with ischemic events is not completely understood and the biology of RPs is still under investigation. We here present a structured review of preclinical and clinical findings concerning the role of RPs in cardiovascular disease.
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Affiliation(s)
- Dario Bongiovanni
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Germany (D.B., J.H., M.K., K.K., G.V., N.S., K.-L.L., I.B.).,Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland (D.B.).,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany (D.B., M.K., M.v.S., K.-L.L., I.B.).,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (D.B., G.C.).,IRCCS Humanitas Research Hospital, Department of Cardiovascular Medicine, Rozzano, Milan, Italy (D.B., G.C.)
| | - Jiaying Han
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Germany (D.B., J.H., M.K., K.K., G.V., N.S., K.-L.L., I.B.)
| | - Melissa Klug
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Germany (D.B., J.H., M.K., K.K., G.V., N.S., K.-L.L., I.B.).,Experimental Bioinformatics, TUM School of Life Sciences Weihenstephan, Technical University of Munich, Germany (M.K.)
| | - Kilian Kirmes
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Germany (D.B., J.H., M.K., K.K., G.V., N.S., K.-L.L., I.B.).,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany (D.B., M.K., M.v.S., K.-L.L., I.B.)
| | - Giacomo Viggiani
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Germany (D.B., J.H., M.K., K.K., G.V., N.S., K.-L.L., I.B.)
| | - Moritz von Scheidt
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany (D.B., M.K., M.v.S., K.-L.L., I.B.).,Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Germany (M.v.S.)
| | - Nina Schreiner
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Germany (D.B., J.H., M.K., K.K., G.V., N.S., K.-L.L., I.B.)
| | - Gianluigi Condorelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (D.B., G.C.).,IRCCS Humanitas Research Hospital, Department of Cardiovascular Medicine, Rozzano, Milan, Italy (D.B., G.C.)
| | - Karl-Ludwig Laugwitz
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Germany (D.B., J.H., M.K., K.K., G.V., N.S., K.-L.L., I.B.).,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany (D.B., M.K., M.v.S., K.-L.L., I.B.)
| | - Isabell Bernlochner
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Germany (D.B., J.H., M.K., K.K., G.V., N.S., K.-L.L., I.B.).,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany (D.B., M.K., M.v.S., K.-L.L., I.B.)
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7
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Len P, Iskakova G, Sautbayeva Z, Kussanova A, Tauekelova AT, Sugralimova MM, Dautbaeva AS, Abdieva MM, Ponomarev ED, Tikhonov A, Bekbossynova MS, Barteneva NS. Meta-Analysis and Systematic Review of Coagulation Disbalances in COVID-19: 41 Studies and 17,601 Patients. Front Cardiovasc Med 2022; 9:794092. [PMID: 35360017 PMCID: PMC8962835 DOI: 10.3389/fcvm.2022.794092] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/11/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction Coagulation parameters are important determinants for COVID-19 infection. We conducted meta-analysis to assess the association between early hemostatic parameters and infection severity. Methods Electronic search was made for papers that addressed clinical characteristics of COVID-19 patients and disease severity. Results were filtered using exclusion and inclusion criteria and then pooled into a meta-analysis to estimate the standardized mean difference (SMD) with 95% confidence interval (CI) for D-dimers, fibrinogen, prothrombin time, platelet count (PLT), activated partial thromboplastin time. To explore the heterogeneity and robustness of our fundings, sensitivity and subgroup analyses were conducted. Publication bias was assessed with contour-enhanced funnel plots and Egger's test by linear regression. Coagulation parameters data from retrospective cohort study of 451 patients with COVID-19 at National Research Center for Cardiac Surgery were included in meta-analysis of published studies. Results Overall, 41 original studies (17,601 patients) on SARS-CoV-2 were included. For the two groups of patients, stratified by severity, we identified that D-dimers, fibrinogen, activated partial thromboplastin time, and prothrombin time were significantly higher in the severe group [SMD 0.6985 with 95%CI (0.5155; 0.8815); SMD 0.661 with 95%CI (0.3387; 0.9833); SMD 0.2683 with 95%CI (0.1357; 0.4009); SMD 0.284 with 95%CI (0.1472; 0.4208)]. In contrast, PLT was significantly lower in patients with more severe cases of COVID-19 [SMD -0.1684 with 95%CI (-0.2826; -0.0542)]. Neither the analysis by the leave-one-out method nor the influence diagnostic have identified studies that solely cause significant change in the effect size estimates. Subgroup analysis showed no significant difference between articles originated from different countries but revealed that severity assessment criteria might have influence over estimated effect sizes for platelets and D-dimers. Contour-enhanced funnel plots and the Egger's test for D-dimers and fibrinogen revealed significant asymmetry that might be a sign of publication bias. Conclusions The hemostatic laboratory parameters, with exception of platelets, are significantly elevated in patients with severe COVID-19. The two variables with strongest association to disease severity were D-dimers and fibrinogen levels. Future research should aim outside conventional coagulation tests and include analysis of clotting formation and platelet/platelet progenitors characteristics.
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Affiliation(s)
- Polina Len
- School of Sciences and Humanities, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Gaukhar Iskakova
- School of Sciences and Humanities, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Zarina Sautbayeva
- School of Sciences and Humanities, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Aigul Kussanova
- School of Sciences and Humanities, Nazarbayev University, Nur-Sultan, Kazakhstan
- Core Facilities, Nazarbayev University, Nur-Sultan, Kazakhstan
| | | | | | - Anar S. Dautbaeva
- National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
| | | | - Eugene D. Ponomarev
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Alexander Tikhonov
- School of Sciences and Humanities, Nazarbayev University, Nur-Sultan, Kazakhstan
| | | | - Natasha S. Barteneva
- School of Sciences and Humanities, Nazarbayev University, Nur-Sultan, Kazakhstan
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
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8
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Barrett TJ, Bilaloglu S, Cornwell M, Burgess HM, Virginio VW, Drenkova K, Ibrahim H, Yuriditsky E, Aphinyanaphongs Y, Lifshitz M, Xia Liang F, Alejo J, Smith G, Pittaluga S, Rapkiewicz AV, Wang J, Iancu-Rubin C, Mohr I, Ruggles K, Stapleford KA, Hochman J, Berger JS. Platelets contribute to disease severity in COVID-19. J Thromb Haemost 2021; 19:3139-3153. [PMID: 34538015 PMCID: PMC8646651 DOI: 10.1111/jth.15534] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/27/2021] [Accepted: 09/16/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Heightened inflammation, dysregulated immunity, and thrombotic events are characteristic of hospitalized COVID-19 patients. Given that platelets are key regulators of thrombosis, inflammation, and immunity they represent prime candidates as mediators of COVID-19-associated pathogenesis. The objective of this study was to understand the contribution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to the platelet phenotype via phenotypic (activation, aggregation) and transcriptomic characterization. APPROACH AND RESULTS In a cohort of 3915 hospitalized COVID-19 patients, we analyzed blood platelet indices collected at hospital admission. Following adjustment for demographics, clinical risk factors, medication, and biomarkers of inflammation and thrombosis, we find platelet count, size, and immaturity are associated with increased critical illness and all-cause mortality. Bone marrow, lung tissue, and blood from COVID-19 patients revealed the presence of SARS-CoV-2 virions in megakaryocytes and platelets. Characterization of COVID-19 platelets found them to be hyperreactive (increased aggregation, and expression of P-selectin and CD40) and to have a distinct transcriptomic profile characteristic of prothrombotic large and immature platelets. In vitro mechanistic studies highlight that the interaction of SARS-CoV-2 with megakaryocytes alters the platelet transcriptome, and its effects are distinct from the coronavirus responsible for the common cold (CoV-OC43). CONCLUSIONS Platelet count, size, and maturity associate with increased critical illness and all-cause mortality among hospitalized COVID-19 patients. Profiling tissues and blood from COVID-19 patients revealed that SARS-CoV-2 virions enter megakaryocytes and platelets and associate with alterations to the platelet transcriptome and activation profile.
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Affiliation(s)
- Tessa J Barrett
- Department of Medicine, New York University Langone Health, New York, New York, USA
| | - Seda Bilaloglu
- Department of Population Health, New York University Langone Health, New York, New York, USA
| | - Macintosh Cornwell
- Department of Medicine, New York University Langone Health, New York, New York, USA
| | - Hannah M Burgess
- Department of Microbiology, New York University Langone Health, New York, New York, USA
| | - Vitor W Virginio
- Department of Medicine, New York University Langone Health, New York, New York, USA
| | - Kamelia Drenkova
- Department of Medicine, New York University Langone Health, New York, New York, USA
| | - Homam Ibrahim
- Department of Medicine, New York University Langone Health, New York, New York, USA
| | - Eugene Yuriditsky
- Department of Medicine, New York University Langone Health, New York, New York, USA
| | - Yin Aphinyanaphongs
- Department of Population Health, New York University Langone Health, New York, New York, USA
| | - Mark Lifshitz
- Department of Pathology, New York University Langone Health, New York, New York, USA
| | - Feng Xia Liang
- DART Microscopy Laboratory, New York University Langone Health, New York, New York, USA
| | - Julie Alejo
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Grace Smith
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Stefania Pittaluga
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Amy V Rapkiewicz
- Department of Pathology, NYU Winthrop Hospital, New York University Langone Health, Mineola, New York, USA
| | - Jun Wang
- Department of Pathology, New York University Langone Health, New York, New York, USA
| | - Camelia Iancu-Rubin
- Department of Pathology, Molecular and Cell-Based Medicine, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ian Mohr
- Department of Microbiology, New York University Langone Health, New York, New York, USA
| | - Kelly Ruggles
- Department of Medicine, New York University Langone Health, New York, New York, USA
| | - Kenneth A Stapleford
- Department of Microbiology, New York University Langone Health, New York, New York, USA
| | - Judith Hochman
- Department of Medicine, New York University Langone Health, New York, New York, USA
| | - Jeffrey S Berger
- Department of Medicine, New York University Langone Health, New York, New York, USA
- Department of Surgery, New York University Langone Health, New York, New York, USA
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9
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Bodrova VV, Shustova ON, Khaspekova SG, Mazurov AV. Platelet reticulated forms, size indexes, and functional activity. Interactions in healthy volunteers. Platelets 2021; 33:398-403. [PMID: 34029503 DOI: 10.1080/09537104.2021.1922659] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Reticulated platelets (RP) are young, functionally active platelet forms which are detected by RNA staining. Their content in the circulation reflects the intensity of bone marrow thrombocytopoesis. The aim of this study was to assess in healthy volunteers the relationship between RP percentage and platelet size and activity. RP were quantitated by thiazole orange staining using flow cytometry. Platelet size indexes included mean platelet volume (MPV), platelet large cell ratio (P-LCR) measured in a Coulter type hematological analyzer and forward scattering (FSC) measured in a flow cytometer. Platelet functional activity was evaluated by expression of activated glycoprotein (GP) IIb-IIIa (PAC-1 antibody binding) and P-selectin with the use of flow cytometry. Platelets were activated by thrombin receptor activating peptide (TRAP) (10 and 1 µM) and ADP (20 and 2.5 µM). The percentage of RP in healthy volunteers varied from 2.9% to 23.8% (mean ± SD ‒ 11.7 ± 4.7%, n = 99) and correlated with all platelet size indexes: MPV, P-LCR and FCS (r from 0.452 to 0.529, p < .001, n = 87-99). On average, RP were distributed at a ratio of 9:1 between 50% subpopulations of large and small platelets according to their FSC index. Expression of GP IIb-IIIa activated form correlated with RP percentage and platelet size indexes when platelets were activated by TRAP and ADP at both applied concentrations (r from 0.309 to 0.560, p from 0.014 to < 0.001, n = 50-62). P-selectin expression correlated with RP percentage and platelet size indexes when platelets were activated by 10 µM TRAP inducing maximum expression of this activation marker (r from 0.332 to 0.556, p from 0.008 to < 0.001, n = 65), but not by weaker agonists: 1 µM TRAP, 20 and 2.5 µM ADP (r < 0.3, n = 54-66). Thus, high RP content in healthy volunteers is associated with increased platelet size and activity in the whole platelet population.
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Affiliation(s)
- Valeria V Bodrova
- National Medical Research Center for Cardiology, Russian Ministry of Health, Moscow, Russian Federation
| | - Olga N Shustova
- National Medical Research Center for Cardiology, Russian Ministry of Health, Moscow, Russian Federation
| | - Svetalana G Khaspekova
- National Medical Research Center for Cardiology, Russian Ministry of Health, Moscow, Russian Federation
| | - Alexey V Mazurov
- National Medical Research Center for Cardiology, Russian Ministry of Health, Moscow, Russian Federation
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10
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Faber J, Hvas AM, Kristensen SD, Grove EL, Adelborg K. Immature Platelets and Risk of Cardiovascular Events among Patients with Ischemic Heart Disease: A Systematic Review. Thromb Haemost 2020; 121:659-675. [PMID: 33302302 DOI: 10.1055/s-0040-1721386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Immature platelets are larger and may be more thrombogenic than mature platelets. This systematic review included studies on the association between mean platelet volume (MPV), immature platelet count (IPC), and immature platelet fraction (IPF) and the risk of major cardiovascular events (MACEs) in patients with acute coronary syndrome (ACS) or stable coronary artery disease (CAD). METHODS The literature search included studies in PubMed, Embase, Web of Science, and Cochrane Library. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Effect estimates that included multivariate adjusted odds ratios, relative risks, or hazard ratios were extracted. RESULTS Forty-two studies were identified. High MPV was positively associated with MACE in 20 of 26 studies of patients with ACS, four of five studies in patients with stable CAD, and in all six studies comprising a combined population with ACS and stable CAD. Using continuous models of MPV in patients with ACS, effect estimates varied from 0.90 (95% confidence interval [CI]: 0.95-1.03) to 1.66 (95% CI: 1.32-2.09). The strength of these associations was broadly similar among patients with stable CAD and in combined populations. Five studies investigated IPC or IPF as exposures and all reported positive associations with MACE among patients with ACS, stable CAD, or in combined populations. CONCLUSION This review demonstrated clear evidence for positive associations between measures of immature platelets and subsequent risk of MACE in acute and stable ischemic heart disease patients.
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Affiliation(s)
- Julie Faber
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Anne-Mette Hvas
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.,Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Steen Dalby Kristensen
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.,Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Erik Lerkevang Grove
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.,Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Kasper Adelborg
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.,Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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11
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Zhao Y, Lai R, Zhang Y, Shi D. The Prognostic Value of Reticulated Platelets in Patients With Coronary Artery Disease: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2020; 7:578041. [PMID: 33195464 PMCID: PMC7644708 DOI: 10.3389/fcvm.2020.578041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/11/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Reticulated platelets (RPs) represent the young population in the circulating platelet pool, indicating platelet turnover. Preliminary studies suggested circulating levels of RPs were associated with cardiovascular events (CVEs) in patients with coronary artery disease (CAD). Methods: This study systematically searched PubMed, Scopus, Embase, and Web of Science for eligible studies which reported RPs as a prognostic factor and the incidence of CVEs in patients with CAD. The risk estimates and 95% confidence intervals (95% CI) were analyzed for adjusted and unadjusted associations separately using random-effects model. Meta-regression and subgroup analysis were used to identify the source of heterogeneity. Funnel plots, Egger's test, and trim and fill methods were used to assess the publication bias. Results: A total of six cohort studies were included in this meta-analysis. Four studies were rated as high quality with the remaining rated as moderate quality. The funnel plot, Egger's test, and trim and fill method suggested the presence of publication bias. The pooled results indicated elevated RPs were associated with a higher risk of composite CVEs [risk ratio (RR), 2.26; 95% CI, 1.72-2.98, with little heterogeneity] and cardiovascular death (RR, 2.33; 95% CI, 1.66-3.28, with little heterogeneity). Based on results of separate meta-analysis, we found RPs might be a good predictor for revascularization but not for myocardial infarction or cerebrovascular events. After adjustment of conventional prognostic factors, the pooled result still suggested the prognostic value of RPs for composite CVEs (RR, 2.00; 95% CI, 1.30-3.08; p < 0.00001, with substantial heterogeneity). Subgroup analysis and meta-regression of adjusted risk estimates revealed that the number of adjustment factors might be the source heterogeneity. Conclusion: Circulating level of RPs might be a useful prognostic marker for CVEs in patients with CAD, even after adjustment of other prognostic factors.
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Affiliation(s)
- Yihan Zhao
- Beijing University of Chinese Medicine, Beijing, China
- Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Runmin Lai
- Beijing University of Chinese Medicine, Beijing, China
- Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ying Zhang
- Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Dazhuo Shi
- Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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12
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Hille L, Lenz M, Vlachos A, Grüning B, Hein L, Neumann FJ, Nührenberg TG, Trenk D. Ultrastructural, transcriptional, and functional differences between human reticulated and non-reticulated platelets. J Thromb Haemost 2020; 18:2034-2046. [PMID: 32428354 DOI: 10.1111/jth.14895] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/22/2020] [Accepted: 05/06/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Reticulated platelets (RP) are the youngest circulating platelets in blood. An increased amount of this subpopulation is associated with higher cardiovascular risk and mortality. OBJECTIVES It is unknown to what extent intrinsic properties of RP contribute to their hyperreactive features. This study is the first providing a multifactorial approach based on ultrastructural, transcriptional, and functional analysis of RP compared to non-RP sorted by flow cytometry. METHODS Reticulated platelets and non-RP were sorted after platelet staining with SYTO 13. Employing transmission electron microscopy, 1089 micrographs were analyzed for platelet size, amounts of intracellular structures, and anatomical surrogates indicating activation. Long and small RNA-sequencing (RNA-seq) were performed for analyzing differential gene expression. Functional analysis of P-selectin-an upregulated mRNA in RP-was performed in healthy subjects and patients on P2Y12 -inhibitors. RESULTS Electron micrographs uncovered distinct ultrastructural differences in RP versus non-RP. Cross sections were 1.9-fold larger in RP (P < .0001). Amounts of α-granules, dense granules, open canalicular system-openings, and mitochondria were increased in RP, which persisted after adjustment for platelet size. Long RNA-seq showed 1212 upregulated transcripts that are predominantly associated to platelet shape change, aggregation, and activation; 1264 mRNAs were downregulated in RP. Small RNA-seq did not reveal any differentially expressed transcripts. Functional analysis displayed higher P-selectin expression as compared to non-RP upon ADP- or TRAP-stimulation. CONCLUSIONS Our results demonstrate that altered intrinsic structural and molecular properties contribute to the hyperreactivity of RP. These properties and an increased amount of RP may account for the association with cardiovascular risk.
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Affiliation(s)
- Laura Hille
- Department of Cardiology and Angiology II, Clinical Pharmacology, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Maximilian Lenz
- Department of Neuroanatomy, Institute of Anatomy and Cell Biology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andreas Vlachos
- Department of Neuroanatomy, Institute of Anatomy and Cell Biology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Basics in Neuromodulation, University of Freiburg, Freiburg, Germany
| | - Björn Grüning
- Bioinformatics Group, Department of Computer Science, University of Freiburg, Freiburg, Germany
| | - Lutz Hein
- Institute of Experimental and Clinical Pharmacology and Toxicology, University of Freiburg, Freiburg, Germany
- BIOSS Centre for Biological Signaling Studies, University of Freiburg, Freiburg, Germany
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Thomas G Nührenberg
- Department of Cardiology and Angiology II, Clinical Pharmacology, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
- Institute of Experimental and Clinical Pharmacology and Toxicology, University of Freiburg, Freiburg, Germany
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Dietmar Trenk
- Department of Cardiology and Angiology II, Clinical Pharmacology, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
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13
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Benlachgar N, Doghmi K, Masrar A, Mahtat EM, Harmouche H, Tazi Mezalek Z. Immature platelets: a review of the available evidence. Thromb Res 2020; 195:43-50. [PMID: 32652352 DOI: 10.1016/j.thromres.2020.06.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 05/12/2020] [Accepted: 06/30/2020] [Indexed: 12/28/2022]
Abstract
Immature platelets or reticulated platelets are newly released thrombocytes. They can be identified by their large size and high RNA cytoplasm concentration. Immature platelet fraction (IPF) represents the percentage of immature circulative platelets to the total number of platelets. The development of analytical standardization of this hematological parameter by new automated devices allowed a better exploration of its contribution in a context of thrombocytopenia. In fact, several studies had confirmed its clinical utility to differentiate immune thrombocytopenia from other causes of thrombocytopenia. IPF can also predict platelets recovery after chemotherapy and successful engraftment. In addition, immature platelets have shown utility in other diseases such as coronary artery diseases, bacterial infections and liver diseases. Despite all these advantages, immature platelet fraction can be increased in some cases of thrombocytopenia characterized by platelets hypoproduction. The aim of this review is to present the immature platelet fraction contribution in clinical practice.
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Affiliation(s)
- Naoufal Benlachgar
- Department of Clinical Haematology, Military Hospital of Instruction Mohamed V, Rabat, Morocco.
| | - Kamal Doghmi
- Department of Clinical Haematology, Military Hospital of Instruction Mohamed V, Rabat, Morocco
| | - Azlarab Masrar
- Central laboratory of hematology, Ibn Sina Hospital, University Mohamed V of Medicine, Rue Lamfadel Cherkaoui, BP 6527 Rabat, Morocco
| | - El Mehdi Mahtat
- Department of Clinical Haematology, Military Hospital of Instruction Mohamed V, Rabat, Morocco
| | - Hicham Harmouche
- Internal Medicine Department, Ibn Sina Hospital, University Mohamed V of Medicine, Rue Lamfadel Cherkaoui, BP 6527 Rabat, Morocco
| | - Zoubida Tazi Mezalek
- Internal Medicine Department, Ibn Sina Hospital, University Mohamed V of Medicine, Rue Lamfadel Cherkaoui, BP 6527 Rabat, Morocco
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14
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Ezer E, Schrick D, Tőkés-Füzesi M, Szapary L, Bogar L, Molnar T. A novel approach of platelet function test for prediction of attenuated response to clopidogrel. Clin Hemorheol Microcirc 2020; 73:359-369. [PMID: 31156147 PMCID: PMC6971826 DOI: 10.3233/ch-190580] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Elevated mean platelet volume (MPV) and immature platelet fraction (IPF) are predictive for vascular risk. Both can be associated with residual platelet reactivity. We aimed to explore associations among platelet characteristics and responder status in stroke patients on clopidogrel. METHODS Blood samples from 46 patients and 15 healthy subjects were analyzed for platelet count, MPV, IPF, large cell ratio (LCR) and high-fluorsecent immature platelet fraction (H-IPF). As a novelty, not only whole blood, but upper and lower half blood samples after 1-hour gravity sedimentation were analyzed. Platelet aggregometry was used for the whole blood and separated samples to explore area under the curve (AUC) in patients and controls. RESULTS The AUC of the whole blood showed significant differences compared to the upper and lower samples separated after 1-hour sedimentation in patients and controls (p < 0.001 and p = 0.005 respectively). Remarkably, AUC measured in the upper samples in 59% of patients on clopidogrel were exceeding the therapeutic range suggesting that ascending platelets exert aggregation in the presence of ADP. This observation was associated with increased MPV and LCR in the upper samples (both p = 0.04). Patients on clopidogrel were characterized as responders and non-responders and the percentage of H-IPF was significantly higher among non-responders compared to controls in the upper samples (p = 0.04). CONCLUSIONS The modified platelet function test may help to stratify patients with high residual platelet reactivity.
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Affiliation(s)
- Erzsebet Ezer
- Department of Anesthesiology and Intensive Care, University of Pecs, Medical School, Pecs, Hungary
| | - Diana Schrick
- Department of Anesthesiology and Intensive Care, University of Pecs, Medical School, Pecs, Hungary
| | - Margit Tőkés-Füzesi
- Department of Laboratory Medicine, University of Pecs, Medical School, Pecs, Hungary
| | - Laszlo Szapary
- Department of Neurology, University of Pecs, Medical School, Pecs, Hungary
| | - Lajos Bogar
- Department of Anesthesiology and Intensive Care, University of Pecs, Medical School, Pecs, Hungary
| | - Tihamer Molnar
- Department of Anesthesiology and Intensive Care, University of Pecs, Medical School, Pecs, Hungary
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15
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Abstract
Abstract
Reticulated platelets are immature platelets freshly released from the bone marrow into the circulation and contain vestigial amounts of ribonucleic acid. Thus, they can serve as an indicator for the activity of thrombopoiesis. Despite the current lack of a standardized reference method, two types of hematology analyzers have incorporated a fully automated measurement of reticulated platelets. The “immature platelet fraction” (IPF; Sysmex XE-/XN-series) has some clinical utility in the differential diagnosis of thrombocytopenia. This is less clear for “reticulated platelets” (retPLT; Abbott CELL-DYN Sapphire/Alinity HQ). The usefulness of these parameters in the prediction of platelet recovery after chemotherapy or stem cell transplantation and as a decision aid for platelet transfusions has not been unequivocally confirmed. Recent findings have shown an association of reticulated platelets with an adverse risk in patients with coronary artery disease and stroke as well as resistance to anti-platelet therapy. Furthermore, a role of reticulated platelets for the prediction of sepsis was indicated. However, validation in larger prospective trials is necessary to establish the clinical benefit of reticulated platelets in these conditions. This review gives an overview of the available analytical methods and summarizes the current knowledge regarding the clinical application of reticulated platelets.
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Affiliation(s)
- Lisa Meintker
- Department of Medicine 5 for Hematology and Oncology , University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg , Erlangen , Germany
| | - Stefan W. Krause
- Department of Medicine 5 for Hematology and Oncology , University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg , Erlangen , Germany
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16
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Perl L, Matatov Y, Koronowski R, Lev EI, Solodky A. Prognostic significance of reticulated platelet levels in diabetic patients with stable coronary artery disease. Platelets 2019; 31:1012-1018. [PMID: 31842657 DOI: 10.1080/09537104.2019.1704712] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Levels of reticulated platelets (RP) increase during high platelet turnover conditions, and have been shown to correlate with diabetes mellitus (DM) status. Little is known regarding the prognostic significance of levels of RP among patients with stable coronary artery disease (SCAD). The study consisted of patients with SCAD and DM, who visited our cardiology outpatient clinic between June 2016 and February 2017. RP levels were measured at baseline as immature platelet fraction (IPF)%, using flow cytometry. Outcomes at 2 years consisted of bleeding events and major adverse cardiovascular events (MACE), which included death, myocardial infarction, cerebrovascular accident and urgent revascularization. The study included 104 patients (mean age - 71.2 ± 9.5 years, 76.9% were male, and 83.7% had hypertension). IPF was significantly higher at baseline among patients who had suffered from a MACE (4.57% vs. 2.53%, p < .001), and lower in patients who had suffered from bleeding events, compared with those who had not (1.57% vs. 3.00%, p = .004). There were higher rates of MACE at higher IPF quartiles (p < .001, AUC-0.770), and higher rates of bleeding at the lowest quartiles (p = .007, AUC-0.781). In SCAD patients with DM, levels of RP are associated with a higher risk of MACE, and inversely correlated with the risk of bleeding.
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Affiliation(s)
- Leor Perl
- Cardiology Department, Rabin Medical Center, Petach-Tikva, the "Sackler" Faculty of Medicine, Tel-Aviv University , Tel-Aviv, Israel
| | - Yuri Matatov
- Cardiology Department, Rabin Medical Center, Petach-Tikva, the "Sackler" Faculty of Medicine, Tel-Aviv University , Tel-Aviv, Israel
| | - Ran Koronowski
- Cardiology Department, Rabin Medical Center, Petach-Tikva, the "Sackler" Faculty of Medicine, Tel-Aviv University , Tel-Aviv, Israel
| | - Eli I Lev
- Department of Cardiology, Assuta Ashdod Medical Center, Ashdod, affiliated with Faculty of Health Sciences, Ben-Gurion University of the Negev , Beer Sheva, Israel
| | - Alejandro Solodky
- Cardiology Department, Rabin Medical Center, Petach-Tikva, the "Sackler" Faculty of Medicine, Tel-Aviv University , Tel-Aviv, Israel
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17
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Meershoek AJA, Leunissen TC, van Waes JAR, Klei WA, Huisman A, de Groot MCH, Hoefer IE, van Solinge WW, Moll FL, de Borst GJ. Reticulated Platelets as Predictor of Myocardial Injury and 30 Day Mortality After Non-cardiac Surgery. Eur J Vasc Endovasc Surg 2019; 59:309-318. [PMID: 31812606 DOI: 10.1016/j.ejvs.2019.06.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 04/09/2019] [Accepted: 06/22/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE A pre-operative marker for identification of patients at risk of peri-operative adverse events and 30 day mortality might be the percentage of young, reticulated platelets (pRP). This study aimed to determine the predictive value of pre-operative pRP on post-operative myocardial injury (PMI) and 30 day mortality, in patients aged ≥ 60 years undergoing moderate to high risk non-cardiac surgery. METHODS The incidence of PMI (troponin I > 0.06 μg/L) and 30 day mortality was compared for patients with normal and high pRP (≥2.82%) obtained from The Utrecht Patient Orientated Database. The predictive pRP value was assessed using logistic regression. A prediction model for PMI or 30 day mortality with known risk factors was compared with a model including increased pRP using the area under the receiving operator characteristics curve (AUROC). RESULTS In total, 26.5% (607/2289) patients showed pre-operative increased pRP. Increased pRP was associated with more PMI and 30 day mortality compared with normal pRP (36.1% vs. 28.3%, p < .001 and 8.6% vs. 3.6%, p < .001). The median pRP was higher in patients suffering PMI and 30 day mortality compared with not (2.21 [IQR: 1.57-3.11] vs. 2.07 [IQR: 1.52-1.78], p = .002, and 2.63 [IQR: 1.76-4.15] vs. 2.09 [IQR: 1.52-3.98], p < .001). pRP was independently related to PMI (OR: 1.28 [95% CI: 1.04-1.59], p = .02) and 30 day mortality (OR: 2.35 [95% CI: 1.56-3.55], p < .001). Adding increased pRP to the predictive model of PMI or 30 day mortality did not increase the AUROC 0.71 vs. 0.72, and 0.80 vs. 0.81. CONCLUSION In patients undergoing major non-cardiac surgery, increased pre-operative pRP is related to 30 day mortality and PMI.
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Affiliation(s)
- Armelle J A Meershoek
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Tesse C Leunissen
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands; Department of Clinical Chemistry and Haematology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Judith A R van Waes
- Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Wilton A Klei
- Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Albert Huisman
- Department of Clinical Chemistry and Haematology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Mark C H de Groot
- Department of Clinical Chemistry and Haematology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Imo E Hoefer
- Department of Clinical Chemistry and Haematology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Wouter W van Solinge
- Department of Clinical Chemistry and Haematology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Frans L Moll
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands.
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18
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Harima K, Honda S, Mikami K, Kitajima M, Urushizaka M, Tomisawa T, Hagii J, Metoki H, Yasujima M, Osanai T. Collagen-Induced Platelet Aggregates, Diabetes, and Aspirin Therapy Predict Clinical Outcomes in Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2019; 28:2302-2310. [PMID: 31174954 DOI: 10.1016/j.jstrokecerebrovasdis.2019.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/15/2019] [Accepted: 05/19/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Aggregation of platelets is a trigger for additional development of larger thrombi. This study aimed to identify factors that may affect platelet aggregability and their role in clinical outcomes in acute ischemic stroke. METHODS Consecutive acute ischemic stroke patients (n = 352) who were transferred within 24 hours after its onset were enrolled. Peripheral venous blood was sampled to measure platelet aggregability and other parameters. RESULTS Mean values of spontaneous small-sized platelet aggregates and collagen- or adenosine diphosphate (ADP)-induced large-sized aggregates were elevated in acute ischemic stroke. In atherothrombotic stroke (n = 178), collagen and ADP-induced large-sized aggregates were positively correlated with HbA1c, respectively. High incidence of the modified Rankin Scales (mRS) 5-6 at discharge was associated with diabetes complication (odds ratio [OR] 8.77, 95% confidence interval [CI] 1.32-57.56). The proportion of patients who were functionally independent (the mRS 0-2) at discharge was lower in the middle tertile of collagen and ADP-induced large-sized aggregates than their low tertile (OR 2.46, 95% CI 1.09-5.58; OR 2.43, 95% CI 1.05-5.59, respectively). Prestroke administration of aspirin recovered the proportion of independence at discharge (OR 0.25, 95% CI 0.06-0.99), and ameliorated incidence of the mRS 5-6. On logistic regression analysis, diabetes, HbA1c, collagen-induced large-sized aggregates, and prestroke administration of aspirin remained independent predictors of clinical outcomes in atherothrombotic stroke. In cardioembolic and lacunar stroke, no relations with clinical outcomes were found. CONCLUSIONS High plasma level of HbA1c is involved in enhanced platelet aggregability in acute atherothrombotic stroke patients, and prestroke administration of aspirin may be beneficial to clinical outcomes.
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Affiliation(s)
- Kaho Harima
- Department of Nursing Science, Hirosaki University Graduate School of Health Science, Hirosaki, Japan
| | - Sumika Honda
- Department of Nursing Science, Hirosaki University Graduate School of Health Science, Hirosaki, Japan
| | - Kasumi Mikami
- Department of Nursing Science, Hirosaki University Graduate School of Health Science, Hirosaki, Japan
| | - Maiko Kitajima
- Department of Nursing Science, Hirosaki University Graduate School of Health Science, Hirosaki, Japan
| | - Mayumi Urushizaka
- Department of Nursing Science, Hirosaki University Graduate School of Health Science, Hirosaki, Japan
| | - Toshiko Tomisawa
- Department of Nursing Science, Hirosaki University Graduate School of Health Science, Hirosaki, Japan
| | - Joji Hagii
- Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan
| | | | | | - Tomohiro Osanai
- Department of Nursing Science, Hirosaki University Graduate School of Health Science, Hirosaki, Japan.
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Verdoia M, Pergolini P, Rolla R, Suryapranata H, Kedhi E, De Luca G. Impact of immature platelet fraction on platelet reactivity during prasugrel maintenance treatment. Platelets 2018; 30:915-922. [DOI: 10.1080/09537104.2018.1535707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Monica Verdoia
- Division of Cardiology, Azienda Ospedaliera-Universitaria “Maggiore della Carità”, Eastern Piedmont University, Novara, Italy
| | - Patrizia Pergolini
- Clinical Chemistry, Azienda Ospedaliera-Universitaria “Maggiore della Carità”, Eastern Piedmont University, Novara, Italy
| | - Roberta Rolla
- Clinical Chemistry, Azienda Ospedaliera-Universitaria “Maggiore della Carità”, Eastern Piedmont University, Novara, Italy
| | | | - Elvin Kedhi
- Division of Cardiology, ISALA Hospital, Zwolle, The Netherlands
| | - Giuseppe De Luca
- Division of Cardiology, Azienda Ospedaliera-Universitaria “Maggiore della Carità”, Eastern Piedmont University, Novara, Italy
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20
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Affiliation(s)
- Peter J Grant
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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21
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Verdoia M, Nardin M, Negro F, Rolla R, De Luca G. Impact of statin therapy on the immature platelet count in patients with coronary artery disease: A single centre cohort study. Int J Cardiol 2018; 272:40-44. [PMID: 30150123 DOI: 10.1016/j.ijcard.2018.08.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 07/30/2018] [Accepted: 08/10/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Statins represent a pivotal therapy among patients with coronary artery disease (CAD), providing both lipid-lowering and pleiotropic, anti-thrombotic and anti-inflammatory benefits. Immature platelet count (IPC) has been proposed as the fraction of younger and potentially more reactive platelets, therefore potentially affecting the risk of major cardiovascular ischemic events. The aim of the present study was to evaluate the impact of statin therapy on IPC in patients with CAD. METHODS Patients undergoing coronary angiography in a single centre were included. IPC levels were measured by routine blood cells count (A Sysmex XE-2100) as the product of immature platelet fraction (IPF) and platelet count, in patients naïve or chronically treated with statins at admission. RESULTS We included in our study 642 patients, 61.2% treated with statins at admission. Patients on chronic statins were more often males, with a worse metabolic profile, but for lower total and LDL cholesterol, and a higher prevalence of major cardiovascular risk factors. The mean levels of IPC did not differ between statin treated and naive patients (7.9 ± 4.7 vs 7.7 ± 5, p = 0.60) and neither the distribution of IPC across tertiles (p = 0.36). In fact, at multivariate regression analysis, statin use was not independently associated with the rate of IPC above the 3rd tertile (adjusted OR[95%CI] = 1.19[0.80-1.79], p = 0.39). Moreover, among the 190 patients that introduced the therapy with statins at admission, the levels of IPC and major platelet parameters did not differ at a median follow-up of 32 days, as compared to chronically treated or non-treated patients. CONCLUSION The present study shows that among patients with CAD the use of statins does not affect the immature platelet count or main platelet parameters.
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Affiliation(s)
- Monica Verdoia
- Department of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy
| | - Matteo Nardin
- Department of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy; Department of Medicine, ASST "Spedali Civili", University of Brescia, Italy
| | - Federica Negro
- Department of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy
| | - Roberta Rolla
- Department of Clinical Chemistry, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy
| | - Giuseppe De Luca
- Department of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy.
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Kleiman NS. Are Immature Platelets Growing Up?: Toward a New Marker of Antiplatelet Drug Resistance. J Am Coll Cardiol 2018; 68:294-296. [PMID: 27417008 DOI: 10.1016/j.jacc.2016.04.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 04/12/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Neal S Kleiman
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas; Section of Interventional Cardiology, Weill Cornell Medical College, New York, New York.
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Abstract
Reticulated platelets (RPs) are immature platelets with high dense granules content and a residual amount of megakaryocyte-derived of mRNA. Increased level of RPs has been found to be an independent predictor of cardiovascular ischemic events, and has been associated with impaired response to various anti-platelet drugs. The study aimed to characterize and compare the surface antigenic properties of reticulated versus mature platelets. Platelets from healthy individuals and diabetic patients were tested at rest and after activation with adenosine diphosphate (ADP). For each patient, we calculated the proportion of RPs and mature platelets using flow cytometry analysis with thiazole orange staining (for RPs) and CD42b platelet-specific antibody. We also tested the surface expression of P-selectin and Annexin V, by double staining flow cytometry in RPs versus mature platelets. A total of 20 subjects were recruited (10 healthy individuals, 10 diabetics). Activation with ADP did not cause a significant change in the proportion of RPs. Following activation, RPs demonstrated a significant increase in the expression of both P-selectin and Annexin V, while mature platelets exhibited a non-significant increase in both markers. These findings were consistent in both healthy subjects and patients with diabetes. In conclusion, RPs have a significantly higher capacity to increase the expression of platelet activation markers compared with mature platelets.
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Abstract
Platelets play a key role in the pathophysiology of coronary artery disease and acute coronary syndromes. Our understanding of platelet function in thrombus formation has increased considerably, resulting in the development of clinically effective treatment strategies and identification of new targets. An underappreciated platelet function is their contribution toward acute and chronic inflammatory processes including atherogenesis. In this review, we discuss the role of platelets in atherosclerosis and thrombosis, platelet function testing, and the pharmacology of currently available antiplatelet drugs.
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Pi L, Che D, Long H, Fang Z, Li J, Lin S, Liu Y, Li M, Bao L, Li W, Zhang Y, Deng Q, Liu T, Zhang L, Gu X. Immature platelets and antiplatelet therapy response to aspirin in Kawasaki disease. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:1353-1362. [PMID: 29872260 PMCID: PMC5973383 DOI: 10.2147/dddt.s163705] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction Kawasaki disease is a kind of systemic vasculitis that mainly damages moderate and small-sized blood vessels, and is a leading cause of coronary artery lesions (CAL). Antiplatelet therapy is a routine component of Kawasaki disease treatment strategies. So it is important to evaluate the antiplatelet effect of aspirin because of the individual biological variability of antiplatelet effect of aspirin. The immature platelet fraction (IPF) has attracted particular attention as it may influence the antiplatelet effect of aspirin. This study investigated the prognostic factors for evaluating the degree of vasculitis and the effect of antiplatelet therapy in children with Kawasaki disease. Materials and methods Blood samples were collected from 44 patients with Kawasaki disease before aspirin treatment and 7 to 10 days after treatment. The IPF counts, percentage of the IPF, and highly fluorescent IPF were detected by a Sysmex XE-5000 instrument. The levels of 11-dehydrothromboxane B2 (11-DH-TXB2), soluble CD40 ligand (sCD40L), and soluble P-selectin (sP-selectin) were measured by ELISA. The correlation between the measured factors and the degree of coronary artery damage in Kawasaki disease was analyzed. Results We found that 11-DH-TXB2, sP-selectin, and sCD40L levels were much more elevated in the CAL group than in the non-coronary artery lesions (NCAL) group before aspirin treatment. The concentrations of 11-DH-TXB2, sCD40L, sP-selectin, and IPF were reduced after aspirin treatment in the NCAL group but not the CAL group. This is related to the degree of coronary artery damage in Kawasaki disease patients. Additionally, 11-DH-TXB2, sCD40L, sP-selectin, and IPF were positively correlated with the degree of coronary artery damage in Kawasaki disease patients. Conclusion The current study suggests that the presence of high plasma concentrations of 11-DH-TXB2, sCD40L, sP-selectin, and IPF can be considered a risk factor and experimental biomarker for CAL in Kawasaki disease patients.
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Affiliation(s)
- Lei Pi
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Di Che
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Haifeng Long
- Department of Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Clinical Laboratory, The First Clinical Medical College, Jinan University, Guangzhou, China
| | - Zhenzhen Fang
- Program of Molecular Medicine, Guangzhou Women and Children's Hospital, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
| | - Jiawen Li
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Shuyi Lin
- Department of Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yunfeng Liu
- Department of Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Meiai Li
- Department of Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Lijuan Bao
- Department of Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wenli Li
- Department of Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yuan Zhang
- Department of Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Qiulian Deng
- Department of Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Techang Liu
- Department of Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Li Zhang
- Department of Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiaoqiong Gu
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Pechlivani N, Ajjan RA. Thrombosis and Vascular Inflammation in Diabetes: Mechanisms and Potential Therapeutic Targets. Front Cardiovasc Med 2018; 5:1. [PMID: 29404341 PMCID: PMC5780411 DOI: 10.3389/fcvm.2018.00001] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/03/2018] [Indexed: 12/14/2022] Open
Abstract
Cardiovascular disease remains the main cause of morbidity and mortality in patients with diabetes. The risk of vascular ischemia is increased in this population and outcome following an event is inferior compared to individuals with normal glucose metabolism. The reasons for the adverse vascular profile in diabetes are related to a combination of more extensive atherosclerotic disease coupled with an enhanced thrombotic environment. Long-term measures to halt the accelerated atherosclerotic process in diabetes have only partially addressed vascular pathology, while long-term antithrombotic management remains largely similar to individuals without diabetes. We address in this review the pathophysiological mechanisms responsible for atherosclerosis with special emphasis on diabetes-related pathways. We also cover the enhanced thrombotic milieu, characterized by increased platelet activation, raised activity of procoagulant proteins together with compromised function of the fibrinolytic system. Potential new therapeutic targets to reduce the risk of atherothrombosis in diabetes are explored, including alternative use of existing therapies. Special emphasis is placed on diabetes-specific therapeutic targets that have the potential to reduce vascular risk while keeping an acceptable clinical side effect profile. It is now generally acknowledged that diabetes is not a single clinical entity but a continuum of various stages of the condition with each having a different vascular risk. Therefore, we propose that future therapies aiming to reduce vascular risk in diabetes require a stratified approach with each group having a "stage-specific" vascular management strategy. This "individualized care" in diabetes may prove to be essential to improve vascular outcome in this high risk population.
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Affiliation(s)
- Nikoletta Pechlivani
- School of Medicine, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Ramzi A Ajjan
- School of Medicine, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
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28
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Grant PJ. Reticulated platelets in poorly controlled diabetes: A new era in the management of residual risk? Diab Vasc Dis Res 2017; 14:467. [PMID: 29050503 DOI: 10.1177/1479164117731373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Verdoia M, Pergolini P, Rolla R, Barbieri L, Schaffer A, Marino P, Bellomo G, Suryapranata H, De Luca G. Impact of Long-Term Dual Antiplatelet Therapy on Immature Platelet Count and Platelet Reactivity. Angiology 2017; 69:490-496. [DOI: 10.1177/0003319717736407] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The immature platelet count (IPC) is a potential marker of platelet reactivity. We assessed the relationship between IPC during chronic dual antiplatelet therapy (DAPT) and the response to antiplatelet drugs (acetylsalycilic acid + clopidogrel/ticagrelor). We included 286 patients: 167 (58.4%) patients received ticagrelor and 119 (41.6%) received clopidogrel. At a median follow-up of 46.5 days, the variation in IPC displayed an absolute median (interquartile range [IQR]) of −11.9 × 103/µL (−182.7 to 160.8), corresponding to a median percentage change in IPC ([%ΔIPC] IQR) of −0.3% (−21.9% to 35.5%), with an increase in IPC levels in those on ticagrelor and a decrease in IPC levels in those on clopidogrel. We observed an inverse association of lower platelet reactivity at different tests and a higher increase in IPC ( r = −0.14, P = .04 for arachidonic acid test; r = −0.12, P = .05 for collagen test; and r = −0.13, P = .02 for adenosine diphosphate test [ADP]). The rate of poor effectiveness of ADP antagonists was the only independent predictor of a ΔIPC above the third tertile (odds ratio [95% confidence interval] = 0.55 [0.32-0.99]; P = .048). We showed that in patients treated with chronic DAPT, an increase in IPC is significantly related to lower levels of platelet reactivity.
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Affiliation(s)
- Monica Verdoia
- Division of Cardiology, Azienda Ospedaliera-Universitaria “Maggiore della Carità”, Eastern Piedmont University, Novara, Italy
| | - Patrizia Pergolini
- Clinical Chemistry, Azienda Ospedaliera-Universitaria “Maggiore della Carità”, Eastern Piedmont University, Novara, Italy
| | - Roberta Rolla
- Clinical Chemistry, Azienda Ospedaliera-Universitaria “Maggiore della Carità”, Eastern Piedmont University, Novara, Italy
| | - Lucia Barbieri
- Division of Cardiology, Azienda Ospedaliera-Universitaria “Maggiore della Carità”, Eastern Piedmont University, Novara, Italy
- Department of Cardiology, Ospedale S. Andrea, Vercelli, Italy
| | - Alon Schaffer
- Division of Cardiology, Azienda Ospedaliera-Universitaria “Maggiore della Carità”, Eastern Piedmont University, Novara, Italy
- Department of Cardiology, Ospedale S. Biagio, Domodossola, Italy
| | - Paolo Marino
- Division of Cardiology, Azienda Ospedaliera-Universitaria “Maggiore della Carità”, Eastern Piedmont University, Novara, Italy
| | - Giorgio Bellomo
- Clinical Chemistry, Azienda Ospedaliera-Universitaria “Maggiore della Carità”, Eastern Piedmont University, Novara, Italy
| | | | - Giuseppe De Luca
- Division of Cardiology, Azienda Ospedaliera-Universitaria “Maggiore della Carità”, Eastern Piedmont University, Novara, Italy
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Comparison of Immature Platelet Count to Established Predictors of Platelet Reactivity During Thienopyridine Therapy. J Am Coll Cardiol 2017; 68:286-293. [PMID: 27417007 DOI: 10.1016/j.jacc.2016.04.056] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/22/2016] [Accepted: 04/12/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Previous data suggest that reticulated platelets significantly affect antiplatelet response to thienopyridines. It is unknown whether parameters describing reticulated platelets can predict antiplatelet response to thienopyridines. OBJECTIVES The authors sought to determine the extent to which parameters describing reticulated platelets can predict antiplatelet response to thienopyridine loading compared with established predictors. METHODS This study randomized 300 patients undergoing elective coronary stenting to loading with clopidogrel 600 mg, prasugrel 30 mg, or prasugrel 60 mg. Adenosine diphosphate (ADP)-induced platelet reactivity was assessed by impedance aggregometry before loading (intrinsic platelet reactivity) and again on day 1 after loading. Multiple parameters of reticulated platelets were assessed by automated whole blood flow cytometry: absolute immature platelet count (IPC), immature platelet fraction, and highly fluorescent immature platelet fraction. RESULTS Each parameter of reticulated platelets correlated significantly with ADP-induced platelet reactivity (p < 0.01 for all 3 parameters). In a multivariable model including all 3 parameters, only IPC remained a significant predictor of platelet reactivity (p < 0.001). In models adjusting each of the 3 parameters for known predictors of on-treatment platelet reactivity including cytochrome P450 2C19 (CYP2C19) polymorphisms, age, body mass index, diabetes, and intrinsic platelet reactivity, only IPC prevailed as an independent predictor (p = 0.001). In this model, IPC was the strongest predictor of on-treatment platelet reactivity followed by intrinsic platelet reactivity. CONCLUSIONS IPC is the strongest independent platelet count-derived predictor of antiplatelet response to thienopyridine treatment. Given its easy availability, together with its even stronger association with on-treatment platelet reactivity compared with known predictors, including the CYP2C19*2 polymorphism, IPC may become the preferred predictor of antiplatelet response to thienopyridine treatment. (Impact of Extent of Clopidogrel-Induced Platelet Inhibition During Elective Stent Implantation on Clinical Event Rate-Advanced Loading Strategies [ExcelsiorLOAD]; DRKS00006102).
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Association of mean platelet volume with impaired myocardial reperfusion and short-term mortality in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Blood Coagul Fibrinolysis 2016; 27:5-12. [PMID: 26258675 DOI: 10.1097/mbc.0000000000000388] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Impaired myocardial reperfusion, defined angiographically by myocardial blush grade (MBG) 0 or 1, is associated with adverse clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to investigate the impact of admission mean platelet volume (MPV) on the myocardial reperfusion and 30-day all-cause mortality in patients with STEMI with successful epicardial reperfusion after primary percutaneous coronary intervention (PCI). A total of 453 patients with STEMI who underwent primary PCI within 12 h of symptoms onset and achieved thrombolysis in myocardial infarction (TIMI) 3 flow at infarct-related artery after PCI were enrolled and divided into two groups based on postinterventional MBG: those with MBG 2/3 and those with MBG 0/1. Admission MPV was measured before coronary angiography. The primary endpoint was all-cause mortality at 30 days. MPV was significantly higher in patients with MBG 0/1 than in patients with MBG 2/3 (10.38 ± 0.98 vs. 9.59 ± 0.73, P < 0.001). The cumulative 30-day all-cause mortality rate was significantly higher in the groups with high MPV and MBG 0/1 (6.8 vs. 1.5%, P = 0.005, 7.6 vs. 1.9%, P = 0.006, respectively). Multivariate logistic regression analysis demonstrated MPV was independently associated with postinterventional impaired myocardial reperfusion (odds ratio 2.684, 95% confidence interval 2.010-3.585, P < 0.001) and 30-day all-cause mortality (hazard ratio 1.763, 95% confidence interval 1.009-3.079, P = 0.046). Increased MPV on admission is an independent predictor of impaired myocardial reperfusion and short-term mortality in patients with STEMI with successful epicardial reperfusion after primary PCI. Admission MPV may be additive to conventional risk factors in patients with STEMI undergoing PCI.
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Oikonomou EK, Repanas TI, Papanastasiou C, Kokkinidis DG, Miligkos M, Feher A, Gupta D, Kampaktsis PN. The effect of in-hospital acquired thrombocytopenia on the outcome of patients with acute coronary syndromes: A systematic review and meta-analysis. Thromb Res 2016; 147:64-71. [PMID: 27689317 DOI: 10.1016/j.thromres.2016.09.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 09/15/2016] [Accepted: 09/22/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND In-hospital acquired thrombocytopenia (TP) is relatively common among patients hospitalized with acute coronary syndromes (ACS). However, its effect on short-term and long-term outcomes has yet to be reviewed systematically. METHODS We conducted a systematic review and meta-analysis of clinical studies assessing the relationship between new-onset in-hospital TP and adverse outcomes among ACS patients. MEDLINE, Scopus and the Cochrane Library were searched for eligible studies published before March 20, 2016. RESULTS Ten studies reporting on a total of 142,161 ACS patients were identified. 8133 patients showed evidence of new-onset TP during the course of their hospitalization. Compared with patients with normal platelet counts, patients with new-onset TP had a prolonged in-hospital stay, significantly higher risk of both short-term mortality (<30days) (Odds ratio (OR) [95% confidence interval (CI)]: 5.58 [3.63-8.57]) and late death (6months to 1year) (OR [95% CI]: 3.45 [2.35-5.07]), as well as a significantly higher risk of major bleeding events in the first 30days (OR [95% CI]: 6.93 [5.13-9.38]). In addition, risk for other secondary cardiovascular endpoints, including recurrent myocardial infarction, stroke, in-hospital heart failure, stent thrombosis and unplanned revascularization was also significantly higher in the TP versus the no TP group. CONCLUSIONS Development of TP during the in-hospital management of ACS patients is a significant predictor of both short- and long-term adverse events, including mortality. In the light of this evidence, clinicians should be cautious and closely monitor abnormal platelet counts that present early following an ACS.
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Affiliation(s)
- Evangelos K Oikonomou
- Society of Junior Doctors, Athens, Greece; National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece.
| | | | - Christos Papanastasiou
- Society of Junior Doctors, Athens, Greece; Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Damianos G Kokkinidis
- Society of Junior Doctors, Athens, Greece; Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Michael Miligkos
- Society of Junior Doctors, Athens, Greece; Laboratory of Biomathematics, University of Thessaly School of Medicine, Larissa, Greece
| | - Attila Feher
- New York Presbyterian Hospital/Weill Cornell Medical College, Department of Medicine, NY, USA
| | - Dipti Gupta
- Memorial Sloan Kettering Cancer Center, Cardiology Service, New York, USA
| | - Polydoros N Kampaktsis
- Society of Junior Doctors, Athens, Greece; New York Presbyterian Hospital/Weill Cornell Medical College, Department of Medicine, NY, USA
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Nylander S, Schulz R. Effects of P2Y12 receptor antagonists beyond platelet inhibition--comparison of ticagrelor with thienopyridines. Br J Pharmacol 2016; 173:1163-78. [PMID: 26758983 PMCID: PMC5341337 DOI: 10.1111/bph.13429] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 11/02/2015] [Accepted: 12/22/2015] [Indexed: 01/21/2023] Open
Abstract
The effect and clinical benefit of P2Y12 receptor antagonists may not be limited to platelet inhibition and the prevention of arterial thrombus formation. Potential additional effects include reduction of the pro-inflammatory role of activated platelets and effects related to P2Y12 receptor inhibition on other cells apart from platelets. P2Y12 receptor antagonists, thienopyridines and ticagrelor, differ in their mode of action being prodrugs instead of direct acting and irreversibly instead of reversibly binding to P2Y12 . These key differences may provide different potential when it comes to additional effects. In addition to P2Y12 receptor blockade, ticagrelor is unique in having the only well-documented additional target of inhibition, the equilibrative nucleoside transporter 1. The current review will address the effects of P2Y12 receptor antagonists beyond platelets and the protection against arterial thrombosis. The discussion will include the potential for thienopyridines and ticagrelor to mediate anti-inflammatory effects, to conserve vascular function, to affect atherosclerosis, to provide cardioprotection and to induce dyspnea.
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Affiliation(s)
| | - Rainer Schulz
- Institute of PhysiologyJustus‐Liebig University GiessenGiessenGermany
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34
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Verdoia M, Pergolini P, Nardin M, Rolla R, Barbieri L, Schaffer A, Marino P, Bellomo G, Suryapranata H, De Luca G. Impact of diabetes on immature platelets fraction and its relationship with platelet reactivity in patients receiving dual antiplatelet therapy. J Thromb Thrombolysis 2016; 42:245-53. [DOI: 10.1007/s11239-016-1348-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Detection and quantification of circulating immature platelets: agreement between flow cytometric and automated detection. J Thromb Thrombolysis 2016; 42:77-83. [DOI: 10.1007/s11239-016-1338-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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36
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Immature platelet fraction and high-on treatment platelet reactivity with ticagrelor in patients with acute coronary syndromes. J Thromb Thrombolysis 2015; 41:663-70. [DOI: 10.1007/s11239-015-1279-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Hoefer T, Armstrong PC, Finsterbusch M, Chan MV, Kirkby NS, Warner TD. Drug-Free Platelets Can Act as Seeds for Aggregate Formation During Antiplatelet Therapy. Arterioscler Thromb Vasc Biol 2015; 35:2122-33. [PMID: 26272940 PMCID: PMC4587545 DOI: 10.1161/atvbaha.115.306219] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 07/30/2015] [Indexed: 12/27/2022]
Abstract
Supplemental Digital Content is available in the text. Objective— Reduced antiplatelet drug efficacy occurs in conditions of increased platelet turnover, associated with increased proportions of drug-free, that is, uninhibited, platelets. Here, we detail mechanisms by which drug-free platelets promote platelet aggregation in the face of standard antiplatelet therapy. Approach and Results— To model standard antiplatelet therapy, platelets were treated in vitro with aspirin, the P2Y12 receptor blocker prasugrel active metabolite, or aspirin plus prasugrel active metabolite. Different proportions of uninhibited platelets were then introduced. Light transmission aggregometry analysis demonstrated clear positive associations between proportions of drug-free platelets and percentage platelet aggregation in response to a range of platelet agonists. Using differential platelet labeling coupled with advanced flow cytometry and confocal imaging we found aggregates formed in mixtures of aspirin-inhibited platelets together with drug-free platelets were characterized by intermingled platelet populations. This distribution is in accordance with the ability of drug-free platelets to generate thromboxane A2 and so drive secondary platelet activation. Conversely, aggregates formed in mixtures of prasugrel active metabolite–inhibited or aspirin plus prasugrel active metabolite–inhibited platelets together with drug-free platelets were characterized by distinct cores of drug-free platelets. This distribution is consistent with the ability of drug-free platelets to respond to the secondary activator ADP. Conclusions— These experiments are the first to image the interactions of inhibited and uninhibited platelets in the formation of platelet aggregates. They demonstrate that a general population of platelets can contain subpopulations that respond strikingly differently to overall stimulation of the population and so act as the seed for platelet aggregation.
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Affiliation(s)
- Thomas Hoefer
- From The William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, United Kingdom (T.H., P.C.A., M.F., M.V.C., T.D.W.); and National Heart and Lung Institute, Imperial College London, London, United Kingdom (N.S.K.)
| | - Paul C Armstrong
- From The William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, United Kingdom (T.H., P.C.A., M.F., M.V.C., T.D.W.); and National Heart and Lung Institute, Imperial College London, London, United Kingdom (N.S.K.)
| | - Michaela Finsterbusch
- From The William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, United Kingdom (T.H., P.C.A., M.F., M.V.C., T.D.W.); and National Heart and Lung Institute, Imperial College London, London, United Kingdom (N.S.K.)
| | - Melissa V Chan
- From The William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, United Kingdom (T.H., P.C.A., M.F., M.V.C., T.D.W.); and National Heart and Lung Institute, Imperial College London, London, United Kingdom (N.S.K.)
| | - Nicholas S Kirkby
- From The William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, United Kingdom (T.H., P.C.A., M.F., M.V.C., T.D.W.); and National Heart and Lung Institute, Imperial College London, London, United Kingdom (N.S.K.)
| | - Timothy D Warner
- From The William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, United Kingdom (T.H., P.C.A., M.F., M.V.C., T.D.W.); and National Heart and Lung Institute, Imperial College London, London, United Kingdom (N.S.K.).
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Freynhofer MK, Gruber SC, Grove EL, Weiss TW, Wojta J, Huber K. Antiplatelet drugs in patients with enhanced platelet turnover: biomarkers versus platelet function testing. Thromb Haemost 2015; 114:459-68. [PMID: 26272640 DOI: 10.1160/th15-02-0179] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 07/27/2015] [Indexed: 12/18/2022]
Abstract
Platelets are key players in atherothrombosis. Antiplatelet therapy comprising aspirin alone or with P2Y12-inhibitors are effective for prevention of atherothrombotic complications. However, there is interindividual variability in the response to antiplatelet drugs, leaving some patients at increased risk of recurrent atherothrombotic events. Several risk factors associated with high on-treatment platelet reactivity (HTPR), including elevated platelet turnover, have been identified. Platelet turnover is adequately estimated from the fraction of reticulated platelets. Reticulated platelets are young platelets, characterised by residual messenger RNA. They are larger, haemostatically more active and there is evidence that platelet turnover is a causal and prognostic factor in atherothrombotic disease. Whether platelet turnover per se represents a key factor in pathogenesis, progression and prognosis of atherothrombotic diseases (with focus on acute coronary syndromes) or whether it merely facilitates insufficient platelet inhibition will be discussed in this state-of-the art review.
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Affiliation(s)
- Matthias K Freynhofer
- Matthias K. Freynhofer, MD, 3rd Department of Medicine, Cardiology, Wilhelminen Hospital, Montleartstraße 37, A-1160, Vienna, Austria, Tel.: +43 1 49150 2301, Fax: +43 1 49150 2309, E-mail:
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Bernlochner I, Goedel A, Plischke C, Schüpke S, Haller B, Schulz C, Mayer K, Morath T, Braun S, Schunkert H, Siess W, Kastrati A, Laugwitz KL. Impact of immature platelets on platelet response to ticagrelor and prasugrel in patients with acute coronary syndrome. Eur Heart J 2015. [DOI: 10.1093/eurheartj/ehv326] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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40
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Baaten CCFMJ, Veenstra LF, Wetzels R, van Geffen JP, Swieringa F, de Witt SM, Henskens YMC, Crijns H, Nylander S, van Giezen JJJ, Heemskerk JWM, van der Meijden PEJ. Gradual increase in thrombogenicity of juvenile platelets formed upon offset of prasugrel medication. Haematologica 2015; 100:1131-8. [PMID: 26113418 DOI: 10.3324/haematol.2014.122457] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 06/22/2015] [Indexed: 12/14/2022] Open
Abstract
In patients with acute coronary syndrome, dual antiplatelet therapy with aspirin and a P2Y12 inhibitor like prasugrel is prescribed for one year. Here, we investigated how the hemostatic function of platelets recovers after discontinuation of prasugrel treatment. Therefore, 16 patients who suffered from ST-elevation myocardial infarction were investigated. Patients were treated with aspirin (100 mg/day, long-term) and stopped taking prasugrel (10 mg/day) after one year. Blood was collected at the last day of prasugrel intake and at 1, 2, 5, 12 and 30 days later. Platelet function in response to ADP was normalized between five and 30 days after treatment cessation and in vitro addition of the reversible P2Y12 receptor antagonist ticagrelor fully suppressed the regained activation response. Discontinuation of prasugrel resulted in the formation of an emerging subpopulation of ADP-responsive platelets, exhibiting high expression of active integrin αIIbβ3. Two different mRNA probes, thiazole orange and the novel 5'Cy5-oligo-dT probe revealed that this subpopulation consisted of juvenile platelets, which progressively contributed to platelet aggregation and thrombus formation under flow. During offset, juvenile platelets were overall more reactive than older platelets. Interestingly, the responsiveness of both juvenile and older platelets increased in time, pointing towards a residual inhibitory effect of prasugrel on the megakaryocyte level. In conclusion, the gradual increase in thrombogenicity after cessation of prasugrel treatment is due to the increased activity of juvenile platelets.
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Affiliation(s)
- Constance C F M J Baaten
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, The Netherlands
| | - Leo F Veenstra
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, The Netherlands
| | - Rick Wetzels
- Central Diagnostic Laboratory, Maastricht University Medical Centre, The Netherlands
| | - Johanna P van Geffen
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, The Netherlands
| | - Frauke Swieringa
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, The Netherlands
| | - Susanne M de Witt
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, The Netherlands
| | - Yvonne M C Henskens
- Central Diagnostic Laboratory, Maastricht University Medical Centre, The Netherlands
| | - Harry Crijns
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, The Netherlands
| | | | | | - Johan W M Heemskerk
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, The Netherlands
| | - Paola E J van der Meijden
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, The Netherlands
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Wu Q, Ren J, Hu D, Jiang P, Li G, Anjum N, Wang G, Gu G, Chen J, Wu X, Liu S, Li Y, Zhao Y, Li J. An elevated percentage of reticulated platelet is associated with increased mortality in septic shock patients. Medicine (Baltimore) 2015; 94:e814. [PMID: 25984667 PMCID: PMC4602582 DOI: 10.1097/md.0000000000000814] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Microcirculatory changes and coagulation disturbances are thought to play a key role in sepsis. Some evidence suggests that the percentage of reticulated platelets (RP%) may be a valuable and cost-effective sepsis screening parameter. This was a prospective study in surgical patients to investigate the potential value of RP% as a predictor of mortality in septic shock patients.This was a prospective study conducted in a surgical critical care center of a Chinese tertiary care hospital. Consecutive septic shock patients were enrolled at admission. Age- and sex-matched non-septic patients were recruited as control patients. RP% was determined by flow cytometry in 68 septic shock patients and 68 controls.Compared with survivors, septic patients who died presented with a significantly higher RP% (P < 0.001). The area under the receiver-operating characteristic curve for the RP% association with mortality was 0.867 (95 % CI 0.780-0.953, P < 0.001). Kaplan-Meier survival curves showed that mortality risk was significantly different when patients were stratified based on RP% (P < 0.001). This association was preserved in a multi-logistic regression analysis that included clinical confounders (P < 0.014).This prospective study demonstrates that increased RP% identifies septic shock patients who have a high risk of death. RP% has the potential to act as a marker for patient stratification in future clinical trials.
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Affiliation(s)
- Qin Wu
- From the Department of General Surgery, Jinling Hospital, Medical School of Nanjing University (QW, JR, DH, GL, NA, GW, GG, JC, XW, SL, YL, YZ, JL); and Department of Hematology, First Affiliated Hospital of Nanjing University of Medicine, Nanjing, China (PJ)
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Mijovic R, Kovacevic N, Zarkov M, Stosic Z, Cabarkapa V, Mitic G. Reticulated platelets and antiplatelet therapy response in diabetic patients. J Thromb Thrombolysis 2015; 40:203-10. [DOI: 10.1007/s11239-014-1165-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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43
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Eikelboom JW, Warkentin TE. Immature Platelet Count. J Am Coll Cardiol 2014; 64:2130-2. [DOI: 10.1016/j.jacc.2014.09.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 09/11/2014] [Indexed: 11/16/2022]
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Berny-Lang MA, Darling CE, Frelinger AL, Barnard MR, Smith CS, Michelson AD. Do immature platelet levels in chest pain patients presenting to the emergency department aid in the diagnosis of acute coronary syndrome? Int J Lab Hematol 2014; 37:112-9. [PMID: 24806286 DOI: 10.1111/ijlh.12250] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 03/27/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Early and accurate identification of acute coronary syndrome (ACS) vs. noncardiac chest pain in patients presenting to the emergency department (ED) is problematic and new diagnostic markers are needed. Previous studies reported that elevated mean platelet volume (MPV) is associated with ACS and predictive of cardiovascular risk. MPV is closely related to the immature platelet fraction (IPF), and recent studies have suggested that IPF may be a more sensitive marker of ACS than MPV. The objective of the present study was to determine whether the measurement of IPF assists in the diagnosis of ACS in patients presenting to the ED with chest pain. METHODS In this single-center, prospective, cross-sectional study, adult patients presenting to the ED with chest pain and/or suspected ACS were considered for enrollment. Blood samples from 236 ACS-negative and 44 ACS-positive patients were analyzed in a Sysmex XE-2100 for platelet count, MPV, IPF, and the absolute count of immature platelets (IPC). RESULTS Total platelet counts, MPV, IPF, and IPC were not statistically different between ACS-negative and ACS-positive patients. The IPF was 4.6 ± 2.7% and 5.0 ± 2.8% (mean ± SD, P = 0.24), and the IPC was 10.0 ± 4.6 and 11.5 ± 7.5 × 10(3) /μL (P = 0.27) for ACS-negative and ACS-positive patients, respectively. CONCLUSION In 280 patients presenting to the ED with chest pain and/or suspected ACS, no differences in IPF, IPC or MPV were observed in ACS-negative vs. ACS-positive patients, suggesting that these parameters do not assist in the diagnosis of ACS.
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Affiliation(s)
- M A Berny-Lang
- Center for Platelet Research Studies, Division of Hematology/Oncology, Boston Children's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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Biomarkers in acute coronary artery disease. Wien Med Wochenschr 2012; 162:489-98. [DOI: 10.1007/s10354-012-0148-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 09/28/2012] [Indexed: 10/27/2022]
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