Platelet Turnover in Stable Coronary Artery Disease – Influence of Thrombopoietin and Low-Grade Inflammation

Abstract

BackgroundNewly formed platelets are associated with increased aggregation and adverse outcomes in patients with coronary artery disease (CAD). The mechanisms involved in the regulation of platelet turnover in patients with CAD are largely unknown.AimTo investigate associations between platelet turnover parameters, thrombopoietin and markers of low-grade inflammation in patients with stable CAD. Furthermore, to explore the relationship between platelet turnover parameters and type 2 diabetes, prior myocardial infarction, smoking, age, gender and renal insufficiency.MethodsWe studied 581 stable CAD patients. Platelet turnover parameters (immature platelet fraction, immature platelet count, mean platelet volume, platelet distribution width and platelet large cell-ratio) were determined using automated flow cytometry (Sysmex XE-2100). Furthermore, we measured thrombopoietin and evaluated low-grade inflammation by measurement of high-sensitive CRP and interleukin-6.ResultsWe found strong associations between the immature platelet fraction, immature platelet count, mean platelet volume, platelet distribution width and platelet large cell ratio (r = 0.61–0.99, p<0.0001). Thrombopoietin levels were inversely related to all of the platelet turnover parameters (r = −0.17–−0.25, p<0.0001). Moreover, thrombopoietin levels were significantly increased in patients with diabetes (p = 0.03) and in smokers (p = 0.003). Low-grade inflammation evaluated by high-sensitive CRP correlated significantly, yet weakly, with immature platelet count (r = 0.10, p = 0.03) and thrombopoietin (r = 0.16, p<0.001). Also interleukin-6 correlated with thrombopoietin (r = 0.10, p = 0.02).ConclusionIn stable CAD patients, thrombopoietin was inversely associated with platelet turnover parameters. Furthermore, thrombopoietin levels were increased in patients with diabetes and in smokers. However, low-grade inflammation did not seem to have a substantial impact on platelet turnover parameters.

Reticulated platelets and antiplatelet therapy response in diabetic patients

“…In our study, %RP strongly correlated with CRP. These data can be supported by the results of Larsen et al who recently demonstrated positive correlation between hsCRP and immature platelet count as well as with thrombopoietin level [15]. Even though vWF Ag values were higher by 5 % in diabetics, they did not correlate with %RP which is in accordance to previous data [14].…”

“…Mean values of %RP in these studies can't be compared to the mean values of %RP obtained by CELL-DYNN Sapphire. Mean values of %RP in our both groups of patients can't be compared with the results of the studies [9,14,15] where IPF was determined by Sysmex technology and one must observe that these studies did not separate diabetics from non-diabetic patients.…”

Association between Circulating Thrombopoietin Levels and Cardiovascular Risk Prediction Scores in Renal Transplant Recipients

“…Levels were elevated in patients within 24 h after ischemic stroke compared to normal controls [28]. Increased TPO levels have also been noted in diabetics, and stable and unstable cardiovascular disease [29,30]. In our study, the TPO levels were not significantly different in RTR with or without diabetes or a history of cardiovascular disease; however, they were associated with the CRCRTR-MACE score, which calculates the cumulative CV-risk based on these and other risk factors.…”

Rising Mean Platelet Volume (MPV) Heralding Platelets Recovery in Dengue?

“…[5] The Platelet Indices (PIs) are believed to have a role in predicting the clinical course in various disease states: from infectious, inflammatory, metabolic to even acute abdomen; and in many of these conditions, platelets are presumed to play a pathogenic role. [6][7][8][9][10] Furthermore, PIs are considered valuable in suggesting the pathophysiologic mechanism of thrombocytopenia. [11] Also, in dengue it is believed to have value in diagnosing and classifying the disease into Dengue Fever (DF) and Severe Dengue.…”