Platelet characteristics in patients with essential thrombocytosis

Pedersen, Oliver Heidmann; Larsen, Mads Lamm; Grove, Erik Lerkevang; Niekerk, Peter Buur van Kooten; Bønløkke, Søren Thorgaard; Nissen, Peter H.; Kristensen, Steen Dalby; Hvas, Anne‐Mette

doi:10.1002/cyto.b.21642

Cited by 36 publications

(30 citation statements)

References 35 publications

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“…Impedance aggregometry results were compared with data on healthy controls chosen to match ECMO patients on two ranked criteria: (a) gender; (b) age. Data on healthy controls for ADP and AA induced platelet aggregation were obtained from Rubak et al (28) and data on TRAP induced platelet aggregation were obtained from Pedersen et al (35).…”

Section: Methodsmentioning

confidence: 99%

Platelet Function During Extracorporeal Membrane Oxygenation in Adult Patients

Balle

Jeppesen

Christensen

et al. 2019

Front. Cardiovasc. Med.

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Objective: Hemorrhagic and thromboembolic complications are common during support with extracorporeal membrane oxygenation (ECMO). As platelets play a pivotal role in hemostasis, we aimed to clarify how ECMO support affects platelet function. Methods: We included 33 adult patients undergoing ECMO support at a tertiary ECMO referral center at Aarhus University Hospital, Denmark. Blood samples were collected on the first morning following ECMO initiation, and subsequently every morning until the 7th (±1) day. Platelet aggregation was evaluated by whole blood impedance aggregometry (Multiplate ® Analyzer) using adenosine diphosphate (ADPtest), arachidonic acid (ASPItest), and thrombin-receptor-agonist-peptide-6 (TRAPtest) as agonists. A new model was applied, taking platelet count into consideration in interpretation of impedance aggregometry analyses. On the 1st and 3rd day, platelet activation was assessed by flow cytometry (Navios) using collagen-related peptide, ADP, TRAP, and arachidonic acid as agonists. Results: Blood samples from all 33 patients were analyzed on day 1 of ECMO support; 24 patients were still receiving ECMO and analyzed on day 3; 12 patients were analyzed on day 7 (±1). After ECMO initiation, platelet counts decreased significantly ( p < 0.002) and remained low during ECMO support. ECMO patients demonstrated significantly reduced platelet aggregation on day 1 compared with healthy controls (all p < 0.001). However, when taking platelet count into consideration, platelet aggregation relative to platelet count did not differ from healthy controls. Flow cytometry analyses demonstrated impaired platelet activation in ECMO patients on day 1 compared with healthy controls (all p < 0.03). No substantial difference was found in platelet activation from day 1 to day 3 on ECMO support. Conclusions: Employing impedance aggregometry and flow cytometry, we found both impaired platelet aggregation and decreased platelet activation on day 1 of ECMO support compared with healthy controls. However, platelet aggregation was not impaired, when interpreted relative to the low platelet counts. Furthermore, levels of bound fibrinogen, on the surface of activated platelets in ECMO patients, were higher than in healthy controls. Together, these findings suggestively oppose that platelets are universally impaired during ECMO support. No marked difference in activation from day 1 to day 3 was seen during ECMO support.

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Section: Methodsmentioning

confidence: 99%

Platelet Function During Extracorporeal Membrane Oxygenation in Adult Patients

Balle

Jeppesen

Christensen

et al. 2019

Front. Cardiovasc. Med.

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“…25 Platelet aggregation measured by impedance aggregometry is known to be positively associated with platelet count. 26,27 Indeed, when platelet aggregation results were divided by platelet count, the difference in antiplatelet effect of aspirin during 24 hours was no longer present indicating that the significantly higher aggregation found could, at least in part, be explained by the higher platelet count in ET patients. However, simply dividing platelet aggregation with platelet count is an imperfect way of adjusting for high platelet count, although studies found a linear relationship between platelet count up to 700 Â 10 9 /L and platelet aggregation.…”

Section: Discussionmentioning

confidence: 98%

Lower Antiplatelet Effect of Aspirin in Essential Thrombocythemia than in Coronary Artery Disease

Pedersen

Hvas

Ommen

et al. 2021

TH Open

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Background Patients with essential thrombocythemia (ET) and coronary artery disease (CAD) have increased risk of thromboembolic complications. In addition, a reduced antiplatelet effect of aspirin has been demonstrated in both patient groups. As ET is a platelet disorder, platelets may be more important for the thromboembolic risk in ET than in CAD. We aimed to investigate the antiplatelet effect of aspirin and platelet turnover in ET versus CAD patients. Methods We included 48 ET patients and an age-matched group of 48 CAD patients. The effect of aspirin was evaluated by thromboxane B2 (TXB2) levels and platelet aggregation. Platelet turnover was assessed by immature platelet count (IPC) and immature platelet fraction (IPF). Results ET patients had reduced effect of aspirin compared with CAD patients, demonstrated by significantly higher TXB2 levels (median of differences = 22.3 ng/mL, p < 0.0001) and platelet aggregation (median of differences = 131.0 AU*min, p = 0.0003). Furthermore, ET patients had significantly higher IPC (p < 0.0001) and IPF (p = 0.0004) than CAD patients. Conclusion ET patients have lower 24-hour antiplatelet effect of aspirin than CAD patients. This may be explained by an increased platelet production and turnover counteracting the antiplatelet effect of aspirin. These findings strengthen the rationale for exploring novel antiplatelet regimens in ET patients to reduce the risk of cardiovascular events.

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“…[ 18 ] Previous studies showed that circulating platelet-leukocyte aggregates are found to more frequent in ET patients with thrombosis. [ 7 ] ET patients with JAK2 mutation have an increased risk of venous and arterial thrombosis. [ 19 ] Furthermore, the occurrence of mucosal and gastrointestinal bleeding was likely due to the inverse relationship between platelet and von Willebrand factor.…”

Section: Discussionmentioning

confidence: 99%

“…[ 4 – 6 ] Essential thrombocytosis is associated with an increased risk of thromboembolic events. [ 7 ] Thrombotic and vascular complications are the chief causes of death in patients with essential thrombocytosis. [ 8 ] In this case, the Korean patient had developed multiple cerebral arterial thrombosis at postoperative day 1 after carotid endarterectomy (CEA).…”

Section: Introductionmentioning

confidence: 99%

Recurrent thrombosis after carotid endarterectomy secondary to activated protein C resistance and essential thrombocytosis

Huh

Han²,

Lee³

et al. 2018

Medicine

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Rationale:Thrombosis is a major cause of morbidity in the perioperative period. Although many risk factors are known, activated protein C resistance is a prominent risk for thrombosis. Activated protein C resistance frequently occurs with recurrent thromboembolism.Patient concerns:A 59-year-old Korean woman patient with hypertension was admitted due to dysarthria and left side motor weakness.Diagnosis and interventions:Magnetic resonance imaging showed subacute cerebral infarction with right frontoparietal lobe and stenosis at the right internal carotid artery. She underwent right carotid endarterectomy under general anesthesia. However, recurrent thrombosis on postoperative day 1 was noted at patient's right carotid artery, which prompted emergency surgery. Additional preoperative laboratory review revealed findings for activated protein C resistance, low protein S activity, antinuclear antibody (>1:160), anti-cardiolipin IgM antibody (16.6), and thrombocytosis, Janus kinase and factor V Leiden mutations. At the intensive care unit, heparin was continually infused until postoperative day 12 and was then switched to warfarin.Outcomes:Patient was discharged at postoperative day 21 without any event. Patient had no signs of recurrence within the 3-year follow-up period, and she is still on oral warfarin and clopidogrel.Lessons:Screening test for hypercoagulability can be used to identify patients at higher risk of postoperative complications. If hypercoagulability state is confirmed by laboratory testing, a suitable anticoagulant treatment plan should be made within the perioperative period.

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Platelet characteristics in patients with essential thrombocytosis

Cited by 36 publications

References 35 publications

Platelet Function During Extracorporeal Membrane Oxygenation in Adult Patients

Platelet Function During Extracorporeal Membrane Oxygenation in Adult Patients

Lower Antiplatelet Effect of Aspirin in Essential Thrombocythemia than in Coronary Artery Disease

Recurrent thrombosis after carotid endarterectomy secondary to activated protein C resistance and essential thrombocytosis

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