Platelet indices in patients with occlusive carotid artery disease

Blood Cell Count Indexes of Systemic Inflammation in Carotid Artery Disease: Current Evidence and Future Perspectives

Carotid artery disease is commonly encountered in clinical practice and accounts for approximately 30% of ischemic strokes in the general population. Numerous biomarkers have been investigated as predictors of the onset and progression of carotid disease, the occurrence of cerebrovascular complications, and overall prognosis. Among them, blood cell count (BCC) indexes of systemic inflammation might be particularly useful, from a pathophysiological and clinical point of view, given the inflammatory nature of the atherosclerotic process. The aim of this review is to discuss the available evidence regarding the role of common BCC indexes, such as the neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio (PLR), mean platelet volume (MPV), platelet distribution width (PDW), and red cell distribution width (RDW), in the diagnosis and risk stratification of carotid artery disease, and their potential clinical applications.

Effects of aspirin resistance and mean platelet volume on vascular access failure in hemodialysis patients

BACKGROUND/AIMS

Maintaining the patency of vascular access (VA) in hemodialysis (HD) patients is important and can be life-saving. We investigated the effects of aspirin resistance and mean platelet volume (MPV) on VA failure in HD patients.

METHODS

We enrolled 163 patients on maintenance HD. VA failure was defined as thrombosis or a decrease of > 50% of the normal vessel diameter, as revealed by angiography.

RESULTS

Aspirin resistance was observed in 17 of 109 patients in whom this parameter was measured, and was not significantly associated with VA failure (p = 0.051). The mean MPV was 9.15 ± 0.05 fL. The 163 patients were grouped by the median MPV value (9.08 fL) at baseline; patients with higher MPVs (n = 82) had lower platelet counts (p = 0.002) and albumin levels (p = 0.009). During 34 months of follow-up, 65 VA failures (39.9%) occurred. The Kaplan-Meier curve revealed significant differences between the two groups in terms of cumulative VA failure (54.1% vs. 35.3%, p = 0.018). On multivariate analysis, the MPV (hazard ratio [HR], 1.794; 95% confidence interval [CI], 1.066 to 3.020; p = 0.028), platelet count (HR, 1.003; 95% CI, 1.001 to 1.006; p = 0.01), and smoking status (HR, 1.894; 95% CI, 1.019 to 3.519; p = 0.043) independently predicted VA failure.

CONCLUSION

A high MPV was associated with an increased risk of VA failure, whereas aspirin resistance showed only a weak association. The MPV may predict VA survival in HD patients.

Usefulness of plateletcrit in the prediction of major adverse cardiac and cerebrovascular events in patients with carotid artery stenosis

Objectives

Platelets play an important role in the pathogenesis of atherosclerosis and the physiopathology of cardiovascular events. Plateletcrit provides complete information on total platelet mass. The relationship between plateletcrit values and long-term outcomes in patients with carotid stenosis is not known. The purpose of the present study is to evaluate the reliability of plateletcrit for predicting major adverse cardiac and cerebrovascular events (MACCE) in patients with carotid stenosis.

Methods

A total of 230 patients with more than 50% stenosis of the carotid artery were retrospectively included in this study. All cases were divided into two groups according to the calculated threshold value of plateletcrit with receiver operating characteristics curve and baseline parameters and clinical outcomes were compared. Univariate and multivariate analyses were used to evaluate the association between the plateletcrit and MACCE.

Results

The cut-off value for plateletcrit was found to be 0.233 for predicting MACCE, with 56.2% sensitivity and 68.0% specificity. High plateletcrit levels were demonstrated to be statistically higher in patients with MACCE (0.247 in the MACCE (+) group vs. 0.213 in the MACCE (–) group, p < 0.001). In the Kaplan–Meier survival analysis, the long-term mortality rate was higher in the high plateletcrit group ( p = 0.006). Multivariate regression analysis showed that plateletcrit was independently associated with MACCE (OR: 2.196, CI: 1.200–4.018; p = 0.011).

Conclusions

Our data suggest that plateletcrit has an independently predictive value for long-term mortality and MACCE, and it can be used as a marker to predict the long-term adverse outcomes in patients with carotid stenosis.

Analysis of mean platelet volume and red blood cell distribution width in recurrent epistaxis

Objectives

Recurrent epistaxis is one of the most common causes of emergency department visits. Although several localized and systemic conditions has been described, the exact cause is unknown in the majority of cases. In our study, we aimed to determine the effect of mean platelet volume (MPV) and red blood cell distribution width (RDW) levels on recurrent epistaxis.

Method

One hundred and thirty six patients with recurrent epistaxis and 170 healthy cases as control group were included in the study. Demographic data, vital signs and the results of complete blood counts were recorded. The patients who had clinical conditions that might affect the levels of MPV or RDW, were excluded. MPV and RDW levels were compared between the two groups.

Results

The median level of MPV was 7.6 fL (IQR25–75%: 7.1–8.4) in the study group and 8.2 fL (IQR25–75%: 7.8–8.9) in the control group (p < 0.001). The median levels of RDW were found in the patient and control groups in order %15.4 (IQR25–75%: 14.5–15.4) and %14.3 (IQR25–75%: 13.4–15.4) (p < 0.001). Systolic blood pressure, leukocyte count, age, sex, RDW and MPV levels that were variables with p levels<0.2, were included in the multivariate analyses. It was determined that high RDW levels increased epistaxis (p < 0.001; OR:1.89 [95% CI:1.53–2.33]) and high MPV levels decreased epistaxis (p < 0.001; OR:0.54 [95% CI:0.39–0.72]).

Conclusion

Low MPV and high RDW levels caused an increased bleeding tendency in patients with recurrent epistaxis. Although exact mechanism is not known, referring those patients for the assessment of etiologic causes would be proper.

Relationship between coronary tortuosity and plateletcrit coronary tortuosity and plateletcrit

Background

Coronary tortuosity (CorT) is a common angiographic finding and may be associated with myocardial ischaemia, even without coronary artery disease. Platelets play a crucial role in inflammatory and thrombotic processes and the physiopathology of cardiovascular disease. Larger platelets are more active enzymatically and have higher thrombotic ability compared to smaller platelets. Plateletcrit (PCT) provides complete information on total platelet mass. We aimed to evaluate the relationship between CorT and PCT in patients with chronic stable angina.

Methods

The medical records of consecutive patients who underwent coronary angiography from January 2013 to January 2016 were retrospectively reviewed for CorT. CorT and clinical, echocardiographic, haematological and biochemical parameters were evaluated. Taking into consideration the inclusion criteria, 106 patients with CorT and 108 with normal coronary angiographies (control group) were included in the study. CorT was defined as three fixed bends during both systole and diastole, with each bend ≥ 45°.

Results

The median PCT, mean platelet volume (MPV), platelet:large-cell ratio (P-LCR), neutrophil:lymphocyte ratio (NLR) and platelet:lymphocyte ratio (PLR) of the CorT group were significantly higher than those of the control group (0.26 ± 0.02 vs 0.2 ± 0.03%, p < 0.001; 10.6 ± 0.14 vs 9.6 ± 0.65 fl, p < 0.001; 29.3 ± 6.7 vs 23.4 ± 5.1, p < 0.001; 2.3 ± 1 vs 1.47 ± 0.48, p < 0.001; 1.28 ± 0.5 vs 0.82 ± 0.23, p < 0.001, respectively). The incidence of diabetes mellitus, hypertension and female gender were significantly higher in the CorT group (18.9 vs 1.9%, p < 0.001, 90.6 vs 50%, p < 0.001, 70.8 vs 44.4%, p < 0.001, respectively). Multivariate logistic regression analysis revealed age, hypertension, diabetes mellitus and plateletcrit were independently associated with CorT.

Conclusion

CorT was associated with increased PCT, MPV, P-LCR, NLR and PLR, even in the absence of coronary artery disease. Age, hypertension, diabetes mellitus and plateletcrit were independently associated with CorT.

Plateletcrit in Ocular Pseudoexfoliation Syndrome

PURPOSE

The aim of this study was to compare all platelet markers, especially plateletcrit (PCT, total platelet mass), in patients with and without ocular pseudoexfoliation (PEX) syndrome.

METHODS

One hundred six patients with ocular PEX syndrome (study group) and 106 individuals without ocular PEX syndrome (control group) were enrolled in this retrospective case-control study. The biochemical/hematological laboratory results of both the study and control groups were analyzed by a clinician blinded to the group assignments. The main outcome measures were the PCT, platelet count (PLT), mean platelet volume (MPV), and platelet distribution width (PDW).

RESULTS

The mean PCT in the study and control groups were 0.206%±0.520% and 0.171%±0.410%, respectively (P<0.001), and the mean PDW in the study and control groups were 16.12%±1.21% and 14.68%±1.40%, respectively (P<0.001). There were no differences in the MPV or mean PLT (P=0.138 and P=0.055, respectively). The PCT cutoff value was 0.180 (area under the receiver operating characteristics curve, 0.706; P<0.001; 65% sensitivity; 74% specificity).

CONCLUSIONS

The PCT and PDW were significantly higher in patients with than without ocular PEX syndrome. These increased parameters may cause microvascular blood flow resistance and the heightened inflammatory response caused by excessive platelet activity, as with other cardiovascular diseases, and may also decrease aqueous humor outflow in ocular PEX syndrome.

Mean platelet volume is associated with aortic intima-media thickness in patients without clinical manifestation of atherosclerotic cardiovascular disease

Objective:

Mean platelet volume (MPV) plays a pivotal role in the pathophysiology of atherosclerotic disease. Thoracic aortic intima-media thickness (IMT) was reported as an earlier marker of preclinical atherosclerosis than carotid IMT. However, the relationship between MPV and aortic IMT was not investigated. We aimed to assess the relationship between thoracic aortic IMT and MPV in patients undergoing transesophageal echocardiography (TEE) examination for different indications.

Methods:

We studied 190 patients (mean age 37.0±12.5 years) who underwent TEE for different indications. The patients who have known atherosclerotic disease were excluded from study. The patients were divided into 2 groups according to the median thoracic aortic IMT values (IMT_low group <13 mm and IMT_high group ≤13 mm). Platelet count and MPV were analyzed with an automated hematology analyzer. A multiple stepwise linear regression analysis was performed to identify the independent associations of thoracic aortic IMT.

Results:

The highest MPV values were observed in the IMT_high group compared with the IMT_low group (9.5±10 fL vs. 10.9±1.2 fL, p<0.001). Also, the IMT_high group had higher age, hs-CRP and uric acid levels (p<0.05 for all). Multiple linear regression analysis showed that aortic IMT was independently related with age (β=0.340, p<0.001), uric acid (β=0.111, p=0.041), hs-CRP (β=0.200, p<0.001), and MPV (β=0.482, p<0.001).

Conclusion:

MPV is independently related to the extent of subclinical thoracic aortic atherosclerosis. Increases in MPV may be a crucial biochemical marker for initial atherosclerosis.

The independent assocıatıon of plateletcrıt wıth long-term outcomes in patıents undergoıng prımary percutaneous coronary interventıon

PURPOSE

Platelets play a key role in the genesis of thrombosis. Plateletcrit (PCT) provides complete information on total platelet mass. The relationship between PCT values and long-term outcomes in patients with ST-segment elevation myocardial infarction (STEMI) who undergo primary angioplasty is not known. We sought to determine the effect of PCT values on the outcomes of primary angioplasty for STEMI.

METHODS

Overall, 2572 consecutive STEMI patients (mean age, 56.6±11.8 years) undergoing primary percutaneous coronary intervention were enrolled retrospectively into the present study. Plateletcrit at admission was measured as part of the automated complete blood count. Patients were classified into 2 groups: high PCT (>0.237, n=852) and nonhigh PCT (<0.237, n=1720). Clinical characteristics and in-hospital and long-term (median, 21 months) outcomes of primary angioplasty were analyzed.

RESULTS

A higher in-hospital shock rate was observed among patients with high PCT values compared with those with nonhigh PCT values (6.5 vs 3.8%, respectively; P=.003). The long-term cardiovascular prognosis was worse for patients with high PCT values (Kaplan-Meier, log-rank test; P=.007). We used Cox proportional hazard models to examine the association between PCT and adverse clinical outcomes. High PCT values were also an independent predictor of cardiovascular mortality (hazard ratio, 1.85; 95% confidence interval, 1.061-3.22; P=.03).

CONCLUSION

High PCT values on admission are independently associated with long-term adverse outcomes in patients with STEMI who undergo primary angioplasty.

Relationship between placental grade and mean platelet volume

This study was performed to investigate the correlation between mean platelet volume, as an indicator of thrombocyte function, and placental grade classified by the Grannum scoring system. Placental sonographic images were graded according to the Grannum scoring system, and synchronous haemogram samples were taken from patients who attended foetal assessments during the second and third trimesters. A total of 75 patients were in their second trimester, and 40 patients were in their third trimester. The relation between week of pregnancy and placental Grannum score was significant (p<0.001); i.e. placental Grannum score increased with gestational age. The association between Grannum score and mean platelet volume was analysed, including trimester and mean platelet volume, by linear regression analysis. The results indicated a distinct trimester-independent correlation between mean platelet volume and Grannum score (partial correlation coefficient=0.455; p<0.001). However, no correlation was observed between Grannum score and gravity (r=0.87; p=0.356), parity (r=0.97; p=0.302) or abortion (r=0.011; p=0.91). The correlation between mean platelet volume and placental calcification was investigated, and mean platelet volume in patients with a calcified placenta was 8.23 ± 1.14, whereas mean platelet volume in placentas with no calcification was 7.92 ± 1.18 (p=0.233). Mean platelet volume was an independent indicator of Grannum score, which is an indicator of placental grade, in women in the second and third trimester of pregnancy. Assessing mean platelet volume during routine screening may identify functional placental disorders.

Plateletcrit. A platelet marker associated with saphenous vein graft disease

BACKGROUND

Saphenous vein graft disease (SVGD) after by-pass surgery is an important cause of morbidity and mortality for patients with coronary artery disease. Comprehensive evaluation of biochemical and hematological parameters associated with this problem is limited. Plateletcrit (PCT) provides complete information on total platelet mass, but it has not been previously studied. In this study, we examined the relationship between SVGD and platelet parameters such as PCT, mean platelet volume, platelet count, and platelet distribution.

METHODS

We retrospectively analyzed 14,398 patients who underwent coronary angiography between February 2006 and August 2012. Records from 893 patients with previous coronary artery by-pass graft operation were re-evaluated. A total of 251 cases were divided into two groups (127 patients receiving a saphenous vein graft; 124 patients diagnosed with SVGD) and hematological and biochemical parameters were compared.

RESULTS

There were no significant differences in clinical characteristics between the two groups except that the SVGD group had a higher median time from surgery to coronary angiography than the patent saphenous vein graft group [7 years (2-16) vs. 5 years (2-15), p < 0.001]. The SVGD groups also had significantly higher median PCT, mean platelet volume, platelet count, uric acid level, and red blood cell distribution width. The cut-off value for PCT was found to be 0.188 for predicting SVGD, with an 80.65 % sensitivity and 81.1 % specificity.

CONCLUSION

Plateletcrit has an important predictive value for SVGD, and it could be used as a marker for anti-platelet therapy to prevent graft atherosclerosis in patients undergoing by-pass surgery.

Relationship between platelet indices and aortic valve sclerosis

OBJECTIVE

Aortic valve sclerosis (AVS) is a progressive disease that is characterized by aortic valve thickening without causing significant narrowing and in which pathology resembles atherosclerotic coronary heart disease. We aimed to evaluate the relationship between AVS and platelet indices including mean platelet volume (MPV), platelet distribution weight (PDW), and platelet count.

METHOD

Two hundred ten patients who were evaluated in the echocardiography unit due to various reasons between January and October 2008 were consecutively included in the study. The patients were divided into 2 groups according to presence or absence of AVS. The patient group consisted of 150 patients (76 females and 74 males; mean age, 64.5 + or - 11.5 years). Patients without AVS (24 females and 36 males; mean age, 49.8 + or - 15.7 years) were assigned as control group. The MPV, PDW, and platelet count were measured.

RESULTS

The MPV (9.56 + or - 1.3 fL vs 9.15 + or - 1.0 fL, P = .022) and PDW (16.9 + or - 2.3% vs 14.9 +/- 2.3, P = .001) were significantly higher in patients with AVS (+) compared to the AVS (-) group. No significant difference was demonstrated between the groups in terms of white blood cell and platelet counts (P > .05). When the AVS (+) group was compared to the AVS (-) group, a significant difference was found in respect of hypertension, diabetes mellitus, and smoking status.

CONCLUSION

Platelet production indices including MPV and PDW were increased in patients with AVS. The complex interrelationship between increased platelet production indices and AVS and value of antithrombotic therapies in patients with AVS need to be evaluated in further studies.

Mean platelet volume in patients with type 2 diabetes mellitus

AIM OF THE STUDY

To evaluate mean platelet volume (MPV) in type 2 diabetic versus non-diabetic patients, as well as to investigate the associations between MPV and diabetic complications.

MATERIALS AND METHODS

This study included 416 patients divided into two groups. Group A comprised 265 type 2 diabetic patients (131 men) with a mean age of 67.4 +/- 9.5 years and a mean diabetes duration of 14.5 +/- 5.7 years. Group B comprised 151 non-diabetic patients (74 men) with a mean age of 68.6 +/- 9.1 years. MPV (blood samples anticoagulated with sodium citrate) was measured in two blood cell counters (Sysmex SF 3000 and Cell-Dyn 3700).

RESULTS

MPV was significantly higher (P = 0.01) in group A (14.2 +/- 2.2 fl) than in group B (7.1 +/- 1.2 fl). In group A MPV was significantly higher (P = 0.043) in patients with retinopathy (15.8 +/- 1.3 fl) than in patients without retinopathy (10.9 +/- 1.1 fl) and also significantly higher (P = 0.044) in patients with microalbuminuria (15.6 +/- 1.2 fl) than in patients without microalbuminuria (10.1 +/- 1.2 fl). No association, however, was found in group A between MPV and age, gender, duration of diabetes, insulin dependency, BMI, HbA1c, coronary artery disease or dyslipidaemia.

CONCLUSIONS

MPV is higher in type 2 diabetic patients than in non-diabetic patients. Among type 2 diabetic patients MPV is higher in those who have microvascular complications (retinopathy or microalbuminuria).

Platelets, alcohol consumption, and onset of brain infarction

OBJECTIVES

Previous investigations have suggested that recurrent rebound thrombocytosis after alcohol misuse may be a factor in the pathogenesis of thromboembolic disease. Alcohol consumption, platelet count, and platelet function were examined among patients of working age with brain infarction.

METHODS

Platelet count and risk factors for stroke were studied in 426 stroke patients and 157 control patients in hospital. The measures were platelet count obtained within four days after the stroke onset, in vitro adenosine diphosphate induced platelet aggregation, associated thromboxane B2 formation, and urinary excretion of 11-dehydrothromboxane B2.

RESULTS

After adjustment for sex, age, cardiac disease, diabetes, and alcohol intake, hypertension (OR 3.4, 95% confidence interval (95% CI) 2.0-6.0) and current smoking (OR 2.1, 95% CI 1.4-3.3) were associated with an increased risk for brain infarction. Platelet count shortly after the onset of disease was higher in the stroke patients than in the controls (OR 1.05/10(10)/1 platelets; 95% CI 1.02-1.09). The patients with brain infarction who were heavy alcohol drinkers (n = 144) showed both thrombocytosis (OR 2.30, 95% CI 0.82-6.44) and thrombocytopenia (OR 3.20, 95% CI 1.19 to 8.59) more often at the onset of the stroke than the other patients with brain infarction. The thromboxane variables showed inconsistent associations with the onset of stroke. There was no consistent platelet abnormality among alcohol misusers at the onset of ischaemic brain infarction.

CONCLUSIONS

Alcohol induced thrombocytopenia and rebound thrombocytosis were both often seen at the onset of brain infarction in patients who were heavy alcohol drinkers. Therefore, other mechanisms which could contribute to the high frequency of recurrences of ischaemic stroke among heavy drinkers should be investigated.