Emerging paradigms in arterial thrombosis

Mean platelet volume is significantly associated with serum levels of thyroid-stimulating hormone in a cohort of older euthyroid subjects

PURPOSE

This retrospective and observational study aimed to establish whether any relationship exists between the values of serum thyroid-stimulating hormone (TSH) and those of the mean platelet volume (MPV) in a large cohort of older euthyroid Italian subjects.

MATERIALS AND METHOD

The study population was represented by a cohort of 1,050 ostensibly healthy and euthyroid patients aged 50 years and older, who were referred for screening of thyroid disorders over a 1-year period.

RESULTS

A significant association was found between MPV and TSH values in both simple (r = 0.12; p < 0.001) and multivariable regression analysis (beta coefficient, 0.07; p < 0.001) after adjustment for age, sex, free thyroxin values and platelet count. After stratification of the study population according to quartiles of serum TSH levels, a graded increase of MPV values was found from the first to the fourth quartile of TSH (p = 0.013). The odds ratio for an increased MPV value of the fourth versus the first quartile of TSH was 1.54 (95% CI, 1.08-2.20; p = 0.017).

CONCLUSIONS

The results of this investigation demonstrate that a significant, positive and independent association exists between MPV and serum TSH values in a large cohort of older euthyroid Italian subjects.

Antithrombotic therapy: new areas to understand efficacy and bleeding

INTRODUCTION

Therapeutic options for antithrombotic therapy are limited due to associated adverse bleeding events. Traditionally, the antithrombotic effects of these agents have been closely linked with concomitant risks in bleeding complications.

AREAS COVERED

This article will review recent developments in the understanding of the mechanisms underlying physiological hemostasis and pathological thrombosis as well as key findings that may serve to 'uncouple' these two processes. In addition, we highlight the recent work identifying novel therapeutic agents targeting these novel mechanisms of pathological thrombus formation.

EXPERT OPINION

Recent research has identified several novel mediators of thrombus formation, including cell-free nucleic acids, histones, histone-DNA complexes and neutrophil extracellular traps that may serve to link inflammation and thrombosis as well as separate physiological hemostasis from pathological thrombosis. Researchers are developing ligands to target these mediators with an achievable goal to identify novel therapies that inhibit thrombus formation without increased bleeding risk.

Platelets: still a therapeutical target for haemostatic disorders

Platelets are cytoplasmatic fragments from bone marrow megakaryocytes present in blood. In this work, we review the basis of platelet mechanisms, their participation in syndromes and in arterial thrombosis, and their potential as a target for designing new antithrombotic agents. The option of new biotechnological sources is also explored.

Novel mediators and biomarkers of thrombosis

Spurred by advances in understanding the molecular basis of thrombosis, this issue of the Journal of Thrombosis and Thrombolysis is devoted to exploring aspects of novel paradigms and their potential impact on diagnosis and treatment. Complex interplay between blood and vascular cells, inflammation, and pro- and anti-coagulant pathways determines the formation and stability of arterial and venous thrombosis. A causal role for inflammation in coronary artery disease is currently being tested in large clinical trials. Basic science observations implicate inflammation in venous thromboembolic disorders and inflammatory processes, may have a similar influence on device thrombosis. In this article and throughout this issue of the Journal, we discuss biomarkers and mediators associated with arterial and venous thrombosis, atrial fibrillation, and other clinical scenarios.