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Bongiovanni D, Novelli L, Condello F, Kirmes K, Han J, Wein B, Elvinger S, Viggiani G, von Scheidt M, Laugwitz KL, Raake PWJ, Kastrati A, Chiarito M, Bernlochner I. Reticulated Platelets Predict Cardiovascular Death and Adverse Events in Coronary Artery Disease: A Systematic Review and Meta-analysis. Thromb Haemost 2024; 124:310-319. [PMID: 37696301 DOI: 10.1055/s-0043-1773763] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
BACKGROUND The pro-thrombotic immature or reticulated platelets (RPs) are known to be elevated in high-risk patients and in different pathological settings. It has been shown that RPs correlate with an insufficient antiplatelet response to antiplatelet agents. RPs are emerging novel predictors of adverse cardiovascular events in cardiovascular disease. This study, using the totality of existing evidence, evaluated the prognostic role of RPs in patients with coronary artery disease. METHODS We performed a systematic review and meta-analysis including trials of acute and chronic coronary syndrome reporting clinical outcomes according to RPs levels in the peripheral blood. We compared patients with elevated RPs (RPshigh) to patients without elevated RPs (RPslow). Odds ratios (ORs) and 95% CIs were used as metric of choice for treatment effects with random-effects models. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE). Secondary endpoints were cardiovascular death, myocardial infarction, ischemic stroke, urgent coronary revascularization and bleedings. RESULTS A total of 7 studies, including 2213 patients, were included. The risk for MACCE was significantly higher in RPshigh compared to RPslow patients (OR 2.67 [1.87; 3.81], I2 = 43.8%). RPshigh were associated with cardiovascular death (OR 2.09 [1.36; 3.22], I2 = 40.4%). No associations for RPshigh were detected with the other singular components of MACCE: myocardial infarction (OR 1.73 [0.89; 3.38] I2 = 60.5%) and stroke (OR 1.72 [0.59; 4.96] I2 = 21%). The risk of bleeding did not differ between groups(OR 0.58 [0.15; 2.22] I2 = 86.1%). CONCLUSION Elevated RPs are significantly associated with increased risk of cardiovascular events and cardiovascular death.
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Affiliation(s)
- Dario Bongiovanni
- Department of Internal Medicine I, Cardiology, University Hospital Augsburg, University of Augsburg, Germany
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center IRCCS and Humanitas University, Rozzano, Milan, Italy
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Laura Novelli
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center IRCCS and Humanitas University, Rozzano, Milan, Italy
| | - Francesco Condello
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center IRCCS and Humanitas University, Rozzano, Milan, Italy
| | - Kilian Kirmes
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jiaying Han
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bastian Wein
- Department of Internal Medicine I, Cardiology, University Hospital Augsburg, University of Augsburg, Germany
| | - Sébastien Elvinger
- Department of Internal Medicine I, Cardiology, University Hospital Augsburg, University of Augsburg, Germany
| | - Giacomo Viggiani
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Moritz von Scheidt
- Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany
| | - Philip W J Raake
- Department of Internal Medicine I, Cardiology, University Hospital Augsburg, University of Augsburg, Germany
| | - Adnan Kastrati
- Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany
| | - Mauro Chiarito
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center IRCCS and Humanitas University, Rozzano, Milan, Italy
| | - Isabell Bernlochner
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany
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2
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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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3
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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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4
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Schamroth Pravda N, Kheifets M, Wiessman M, Leshem-Lev D, Vaknin Assa H, Kornowski R, Talmor-Barkan Y, Perl L. Reticulated Platelets and Their Relationship with Endothelial Progenitor Cells during the Acute Phase of ST-Elevation Myocardial Infarction. J Clin Med 2022; 11:jcm11216597. [PMID: 36362823 PMCID: PMC9655415 DOI: 10.3390/jcm11216597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction: Endothelial progenitor cells (EPC) and reticulated platelets (RP) have central roles in the thrombotic and angiogenetic interactions during ST-elevation myocardial infarction (STEMI). The EPC and RP response in patients with STEMI treated by primary percutaneous intervention (PPCI) has not yet been investigated. Methods: We assessed EPC quantification by the expression of CD133+ and CD34+, and EPC function by the capacity of the cells to form colony-forming units (CFU) and MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide) during the acute phase of STEMI. These measurements were correlated with RP at baseline and after 24 h following PPCI. Results: Our cohort included 89 consecutive STEMI-diagnosed patients enrolled between December 2018 and July 2021. At baseline, there was a strong positive correlation between reticulated platelet quantity and MTT levels (R = 0.766 and R2 = 0.586, p < 0.001), CD34+ levels (R = 0.602, and R2 = 0.362, p < 0.001); CD133+ levels (R = 0.666 and R2 = 0.443, p < 0.001) and CFU levels (R = 0.437, R2 = 0.191, p < 0.001). The multiple linear regression showed that levels of MTT (adjusted R2 = 0.793; p < 0.001), CD34+ and CD133+ (adjusted R2 = 0.654; p < 0.001 and adjusted R2 = 0.627; p < 0.001, respectively) had strong independent correlations with RP response. At 24 h after PPCI, the correlation between RP quantity and EPC markers was not significant, except for MTT levels (R = 0.465, R2 = 0.216, p < 0.001). Conclusions: In patients with STEMI, higher levels of RP at baseline are significantly correlated with a more potent EPC response. The translational significance of these findings needs further investigation.
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Affiliation(s)
- Nili Schamroth Pravda
- Department of Cardiology, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence:
| | - Mark Kheifets
- Department of Cardiology, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Maya Wiessman
- Department of Cardiology, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Dorit Leshem-Lev
- Felsenstein Medical Research Center, Rabin Medical Center, Petach Tikvah 4941492, Israel
| | - Hana Vaknin Assa
- Department of Cardiology, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Yeela Talmor-Barkan
- Department of Cardiology, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Leor Perl
- Department of Cardiology, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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5
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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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6
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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: 93] [Impact Index Per Article: 31.0] [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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7
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Abstract
Neonatal megakaryopoiesis and platelet turnover form a developmentally unique pattern by generating a pool of newly released reticulated platelets from the bone marrow into the circulation. Reticulated platelets are more reactive and hyperaggregable compared to mature platelets, due to their high residual mRNA content, large size, increased expression of platelet surface receptors, and degranulation. The proportion of reticulated platelets in neonates is higher compared to that in adults. Due to the emergence of an uninhibited platelet subpopulation, the newly formed reticulated platelet pool is inherently hyporesponsive to antiplatelets. An elevated population of reticulated platelets is often associated with increased platelet reactivity and is inversely related to high on-treatment platelet reactivity, which can contribute to ischemia. Measurements of the reticulated platelet subpopulation could be a useful indicator of increased tendency for platelet aggregation. Future research is anticipated to define the distinct functional properties of newly formed reticulated or immature platelets in neonates, as well as determine the impact of enhanced platelet turnover and high residual platelet reactivity on the response to antiplatelet agents.
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Affiliation(s)
- Belay Tesfamariam
- Division of Pharmacology and Toxicology, 372792Center for Drug Evaluation and Research, Silver Spring, MD, USA
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8
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Imperiali CE, Lopez-Delgado JC, Dastis-Arias M, Sanchez-Navarro L. Biomaker evaluation for major adverse cardiovascular event development in patients undergoing cardiac Surgery. ADVANCES IN LABORATORY MEDICINE 2020; 1:20200031. [PMID: 37360622 PMCID: PMC10197270 DOI: 10.1515/almed-2020-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/22/2020] [Indexed: 06/28/2023]
Abstract
Objectives The postoperative period of cardiac surgery (CS) is associated with the development of major adverse cardiovascular events (MACEs). However, the evaluation of MACE after CS by means of biomarkers is poorly developed. We aimed to evaluate postoperative biomarkers that could be associated with MACE. Methods Two Hundred and ten patients who underwent CS were enrolled during the study period. The diagnosis of MACE was defined as the presence of at least one of the following complications: acute myocardial infarction, heart failure, stroke presented during intensive care unit (ICU) stay, and 30-day mortality after CS. High-sensitive troponin T (hs-TnT), C-reactive protein, procalcitonin, interleukin-6, and immature platelet fraction (IPF) were measured on ICU admission and after 24 h. The difference between both measurements (Δ) was calculated to assess their association with MACE. Early infected patients (n=13) after CS were excluded from final analysis. Results The most frequent surgery was single-valve surgery (n=83; 38%), followed by coronary artery bypass graft (n=72; 34%). Postoperative MACE was diagnosed in 31 (14.8%) patients. Biomarker dynamics showed elevated values at 24 h compared with those at ICU admission in patients with MACE versus no-MACE. Multivariate analysis showed that ΔIPF (OR: 1.47; 95% CI: 1.110-1.960; p=0.008) and Δhs-TnT (OR: 1.001; 95% CI: 1.0002-1.001; p=0.008) were independently associated with MACE. Conclusions These findings suggest that postoperative ΔIPF and Δhs-TnT may be useful biomarkers for the identification of patients at risk of MACE development.
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Affiliation(s)
- Claudia E. Imperiali
- Clinical Laboratory, Hospital Universitari de Bellvitge. L’Hospitalet de Llobregat, Barcelona, Spain
- Biochemistry and Molecular Biology Department, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Juan C. Lopez-Delgado
- Critical Care Unit, Hospital Universitari de Bellvitge. L’Hospitalet de Llobregat, Barcelona, Spain
| | - Macarena Dastis-Arias
- Clinical Laboratory, Hospital Universitari de Bellvitge. L’Hospitalet de Llobregat, Barcelona, Spain
| | - Lourdes Sanchez-Navarro
- Clinical Laboratory, Hospital Universitari de Bellvitge. L’Hospitalet de Llobregat, Barcelona, Spain
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9
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Schaller SJ, Fuest K, Ulm B, Schmid S, Bubb C, von Eisenhart-Rothe R, Friess H, Kirchhoff C, Stadlbauer T, Luppa P, Blobner M, Jungwirth B. Substitution of perioperative albumin deficiency disorders (SuperAdd) in adults undergoing vascular, abdominal, trauma, or orthopedic surgery: protocol for a randomized controlled trial. Trials 2020; 21:726. [PMID: 32811539 PMCID: PMC7433099 DOI: 10.1186/s13063-020-04626-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 07/26/2020] [Indexed: 12/29/2022] Open
Abstract
Background Hypalbuminemia is associated with numerous postoperative complications, so a perioperative albumin substitution is often considered. The objective of SuperAdd is to investigate whether substitution of human albumin, aiming to maintain a serum concentration > 30 g/l, can reduce postoperative complications in normovolemic surgical patients in comparison with standard care. Methods/design SuperAdd is a single-center, prospective, randomized, outcome-assessor blinded, patient blinded controlled trial. The primary outcome is the frequency of postoperative complications identified using the Postoperative Morbidity Survey graded ≥ 2 according to the Clavien-Dindo Score. Adult patients at risk to develop hypalbuminemia, i.e., ASA III or IV or high-risk surgery, are recruited after written informed consent was obtained. The albumin concentration is assessed before the induction of anesthesia and every 3 h until admission to the postanesthesia care unit. If albumin concentrations drop below 30 g/l, patients are randomly allocated to the control or the treatment group. The study intervention is a goal-directed human albumin substitution aimed at a concentration > 30 g/l during surgery and postanesthesia care unit stay. The patients in the control group are treated according to standard clinical care. Postoperative visits are to be performed on days 1, 3, 5, 8, and 15, as well as by telephone 6 months after surgery. Discussion SuperAdd is the first clinical trial in a surgical population investigating the effect of a goal-directed albumin substitution aiming at a serum level > 30 g/l. The nonrestrictive selection of patients guarantees that the patients without albumin screening will most likely not develop hypalbuminemia, thus ensuring generalizability of the study results. Trial registration EudraCT 2016-001313-24. Registered on 5 September 2016. Clinical Trials NCT03167645. Registered on 18 October 2016 and has the Universal Trial Number (UTN) U1111-1181-2625.
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Affiliation(s)
- Stefan J Schaller
- Department of Anesthesiology and Intensive Care, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany.,Department of Anesthesiology and Operative Intensive Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117, Berlin, Germany
| | - Kristina Fuest
- Department of Anesthesiology and Intensive Care, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany
| | - Bernhard Ulm
- Department of Anesthesiology and Intensive Care, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany
| | - Sebastian Schmid
- Department of Anesthesiology and Intensive Care, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany.,Department of Anesthesiology, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Catherina Bubb
- Department of Anesthesiology and Intensive Care, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany.,Department of Anesthesiology, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopedics, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany
| | - Helmut Friess
- Department of Surgery, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany
| | - Chlodwig Kirchhoff
- Department of Traumatology, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany
| | - Thomas Stadlbauer
- Department of Vascular Surgery, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany
| | - Peter Luppa
- Institute of Clinical Chemistry and Pathobiochemistry, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany
| | - Manfred Blobner
- Department of Anesthesiology and Intensive Care, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany.,Department of Anesthesiology, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Bettina Jungwirth
- Department of Anesthesiology and Intensive Care, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany. .,Department of Anesthesiology, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
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10
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Effects of Time-Interval since Blood Draw and of Anticoagulation on Platelet Testing (Count, Indices and Impedance Aggregometry): A Systematic Study with Blood from Healthy Volunteers. J Clin Med 2020; 9:jcm9082515. [PMID: 32759828 PMCID: PMC7465339 DOI: 10.3390/jcm9082515] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 11/17/2022] Open
Abstract
Platelet count, indices (mean volume, young-immature platelet fraction) and aggregation are widely used laboratory parameters to investigate primary hemostasis. We performed a systematic, thorough evaluation of the influence of the time-interval since blood draw from 20 healthy individuals and of the anticoagulation of collected blood on such parameters. Blood was anticoagulated with citrate, K2-ethylenediaminetetraacetic acid (EDTA) and hirudin and analyzed 5, 30, 60, 120 and 180 min after blood draw. Multiple electrode aggregometry (MEA) was performed with either hirudin (half-diluted with NaCl) or citrate samples (half-diluted with NaCl or CaCl2 3 mM). Platelet count and indices (Sysmex XN-20) were rather stable over time with EDTA blood. MEA results were lower with citrate blood than with hirudin blood; supplementation with calcium was partially compensatory. MEA results were also lower when performed less than 30 or more than 120 min after blood draw. Platelet clumping, quantitatively estimated with microscope examination of blood smears, was more important in hirudin blood than citrate or EDTA blood and could explain some of the differences observed between preanalytical variables. The results stress once more the importance of preanalytical variables in hemostasis laboratory testing. Decision thresholds based on those tests are only applicable within specific preanalytical conditions.
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11
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Wustrow I, Ebner C, Langwieser N, Haller B, Luppa PB, Bradaric C, Bongiovanni D, Stundl A, Laugwitz KL, Ibrahim T, Bernlochner I. Influence of diagnosis of venous thromboembolism on immature platelets, absolute platelet count and platelet aggregation over time. Platelets 2020; 32:398-403. [PMID: 32316806 DOI: 10.1080/09537104.2020.1754380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The extent of the involvement of platelets in venous thromboembolisms (VTE) is still not fully understood. Immature platelets are large, RNA-rich, prothrombotic platelets. They are involved in arterial thromboembolisms and are associated with adverse cardiovascular events. Their role in VTE has not been investigated before. The aim of this study was to assess different platelet parameters including immature platelet fraction (IPF), immature platelet count (IPC), absolute platelet count and platelet aggregation (PA) over time in patients with VTE at time of diagnosis, as well as at 3-10 days and at 90-110 days after diagnosis. 50 healthy volunteers similar in age and sex to patients served as controls at diagnosis. IPF was measured by the Sysmex XE-5000 analyzer, PA was assessed using the Multiplate analyzer. Diagnosis of VTE had no relevant effect on IPF and IPC whereas absolute platelet count and PA were significantly decreased compared to controls. In the course of VTE, IPF decreased significantly, whereas IPC, absolute platelet count and PA increased. In conclusion, VTE was associated with relevant changes of the absolute platelet count and PA at diagnosis, as well as changes in IPF and IPC over time reflecting a relevant and measurable platelet consumption in VTEs.
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Affiliation(s)
- Isabel Wustrow
- Medizinische Klinik Und Poliklinik I, Klinikum rechts der Isar der, Technischen Universität München, Munich, Germany
| | - Christopher Ebner
- Medizinische Klinik Und Poliklinik I, Klinikum rechts der Isar der, Technischen Universität München, Munich, Germany
| | - Nicolas Langwieser
- Medizinische Klinik Und Poliklinik I, Klinikum rechts der Isar der, Technischen Universität München, Munich, Germany
| | - Bernhard Haller
- Institute for Medical Informatics, Statistics and Epidemiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Peter B Luppa
- Institute for Clinical Chemistry and Pathobiochemistry, Klinikum rechts der Isar der, Technischen Universität München, Munich, Germany
| | - Christian Bradaric
- Medizinische Klinik Und Poliklinik I, Klinikum rechts der Isar der, Technischen Universität München, Munich, Germany
| | - Dario Bongiovanni
- Medizinische Klinik Und Poliklinik I, Klinikum rechts der Isar der, Technischen Universität München, Munich, Germany
| | - Anja Stundl
- Medizinische Klinik Und Poliklinik I, Klinikum rechts der Isar der, Technischen Universität München, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Medizinische Klinik Und Poliklinik I, Klinikum rechts der Isar der, Technischen Universität München, Munich, Germany.,Partner Site Munich Heart Alliance, DZHK (German Centre for Cardiovascular Research), Munich, Germany
| | - Tareq Ibrahim
- Medizinische Klinik Und Poliklinik I, Klinikum rechts der Isar der, Technischen Universität München, Munich, Germany
| | - Isabell Bernlochner
- Medizinische Klinik Und Poliklinik I, Klinikum rechts der Isar der, Technischen Universität München, Munich, Germany.,Partner Site Munich Heart Alliance, DZHK (German Centre for Cardiovascular Research), Munich, Germany
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12
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Bernlochner I, Klug M, Larasati D, Von Scheidt M, Santovito D, Hristov M, Weber C, Laugwitz KL, Bongiovanni D. Sorting and magnetic-based isolation of reticulated platelets from peripheral blood. Platelets 2020; 32:113-119. [PMID: 32046562 DOI: 10.1080/09537104.2020.1724923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Reticulated Platelets (RPs) are large, RNA-rich, prothrombotic and hyperactive platelets known to be elevated in high-risk populations such as diabetics and patients with acute coronary syndrome. High levels of RPs correlate with mortality and adverse cardiovascular events in patients with coronary artery disease as well as with an insufficient antiplatelet response to thienopyridines and aspirin after percutaneous coronary interventions, making them an appealing drug target. However, processing of platelets is challenging and no specific marker for RPs exists. Until now, the gold standard laboratory-based method to study them is based on the flow cytometric measurement of their cell size and their RNA-content with the fluorescent dye Thiazole Orange (TO). Nevertheless, standardized protocols for staining and processing of RPs are missing and the existing techniques were not applied for cell sorting. We provide here a structured and reproducible method to detect, isolate and collect RPs from peripheral blood by RNA-specific staining with TO implementing several platelet inhibitors as well as magnetic labeling allowing sufficient cell recovery and deep biological investigation of these platelets.
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Affiliation(s)
- Isabell Bernlochner
- Medical Department 1, Cardiology, Klinikum Rechts Der Isar, Technische Universität , Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance , Munich, Germany
| | - Melissa Klug
- Medical Department 1, Cardiology, Klinikum Rechts Der Isar, Technische Universität , Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance , Munich, Germany
| | - Ditya Larasati
- Medical Department 1, Cardiology, Klinikum Rechts Der Isar, Technische Universität , Munich, Germany
| | - Moritz Von Scheidt
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance , Munich, Germany.,Department of Cardiology, Deutsches Herzzentrum München, Technische Universität , Munich, Germany
| | - Donato Santovito
- Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-University Munich , Munich, Germany
| | - Michael Hristov
- Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-University Munich , Munich, Germany
| | - Christian Weber
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance , Munich, Germany.,Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-University Munich , Munich, Germany
| | - Karl-Ludwig Laugwitz
- Medical Department 1, Cardiology, Klinikum Rechts Der Isar, Technische Universität , Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance , Munich, Germany
| | - Dario Bongiovanni
- Medical Department 1, Cardiology, Klinikum Rechts Der Isar, Technische Universität , Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance , Munich, Germany.,Department of Cardiovascular Medicine, Humanitas Clinical and Research Center , Rozzano, Milan, Italy
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13
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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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14
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Immature Platelets: The Heart of the Matter in Peri-Operative Cardiac Risk Assessment? Eur J Vasc Endovasc Surg 2019; 59:319. [PMID: 31812607 DOI: 10.1016/j.ejvs.2019.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/13/2019] [Indexed: 11/20/2022]
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15
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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: 7] [Impact Index Per Article: 1.4] [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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16
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Imperiali CE, Lopez-Delgado JC, Dastis-Arias M, Sanchez-Navarro L. Evaluation of the delta of immature platelet fraction as a predictive biomarker of inflammatory response after cardiac surgery. J Clin Pathol 2019; 73:335-340. [PMID: 31732619 DOI: 10.1136/jclinpath-2019-206068] [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: 06/29/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 12/23/2022]
Abstract
AIMS Cardiac surgery (CS) can induce an inflammatory response (IR) that is associated with poorer outcomes. Immature platelets are among the factors that may be associated with IR development. We aimed to evaluate whether immature platelet fraction (IPF) could be a predictive biomarker for IR and whether IPF could improve the prognosis assessment of IR for Acute Physiologic and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment (SOFA) following CS. METHODS Three-hundred and twenty-seven (327) patients who underwent CS were enrolled during the study period. IR was defined according to the need for vasopressor support (>48 hours). Perioperative variables and outcomes were registered in our database. IPF was measured immediately following CS and at 24 hours by Sysmex XN analyzer and the difference between both measurements (ΔIPF) was calculated. To assess the relationship between ΔIPF and IR, univariate and multivariate logistic regression were performed. To analyse the additive value of ΔIPF in APACHE II and SOFA scores in predicting IR, an area under the receiver operating characteristic (AUROC) curve was calculated. RESULTS Among 327 patients included, 60 patients (18.3%) developed IR. Multivariate analysis showed ΔIPF was significantly associated with IR (OR: 1.26; 95% CI: 1.01 to 1.56; p=0.038). The combination of ΔIPF with scores improved the AUROC for IR prediction: 0.629 vs 0.728 (p=0.010) for APACHE II and 0.676 vs 0.715 (p=0.106) for SOFA. CONCLUSION These findings suggested that ΔIPF may be a useful and low-cost biomarker for the early identification of patients at risk of IR development.
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Affiliation(s)
- Claudia Elizabeth Imperiali
- Clinical Laboratory, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain .,Biochemistry and Molecular Biology Department, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Macarena Dastis-Arias
- Clinical Laboratory, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Lourdes Sanchez-Navarro
- Clinical Laboratory, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
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17
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Goedel A, Müller S, Schwerdtfeger C, Zink A, Noe S, Bongiovanni D, Haller B, Spinner CD, Bernlochner I. Influence of antiretroviral therapy and cardiovascular disease on the immature platelet fraction in patients living with HIV. Platelets 2019; 31:756-762. [PMID: 31608753 DOI: 10.1080/09537104.2019.1678114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Cardiovascular disease is an important contributor to morbidity and mortality in people living with HIV . The immature platelet fraction (IPF) is increased in HIV-negative patients with cardiovascular disease and evidence suggests that an enlarged IPF is associated with adverse cardiovascular events. In this multi-center observational study, we aimed to investigate how the IPF in people living with HIV is influenced by antiretroviral therapy and cardiovascular disease. Subjects without cardiovascular disease that received antiretroviral therapy showed a smaller IPF accompanied by lower D-dimer and C-reactive protein (CRP) levels compared to therapy-naïve subjects (mean IPF: 2.9% vs. 3.9%, p = .016; median D-dimer: 252 µg/L vs. 623 µg/L, p < .001; median CRP: 0.2 mg/dL vs. 0.5 mg/dL, p = .004). No significant differences for the IPF, D-dimer or CRP were found between subjects on antiretroviral therapy with documented cardiovascular disease and therapy-naïve subjects. In conclusion, we observed a reduction in the IPF among subjects on therapy only in the absence of cardiovascular disease. In contrast, subjects receiving therapy that had documented cardiovascular disease showed an IPF comparable to therapy-naïve subjects. Future studies are needed to investigate if an enlarged IPF may serve as a biomarker in predicting adverse cardiovascular events in people living with HIV.
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Affiliation(s)
- A Goedel
- Department of Medicine I, Technical University of Munich, School of Medicine, University Hospital Klinikum rechts der Isar , Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance , Munich, Germany
| | - S Müller
- Department of Medicine II, Technical University of Munich, School of Medicine, University Hospital Klinikum rechts der Isar , Munich, Germany
| | - C Schwerdtfeger
- Department of Medicine II, Technical University of Munich, School of Medicine, University Hospital Klinikum rechts der Isar , Munich, Germany.,DZIF (German Center for Infection Research), partner site Munich , Munich, Germany
| | - A Zink
- Department of Dermatology and Allergology, Technical University of Munich, School of Medicine, University Hospital Klinikum rechts der Isar , Munich, Germany
| | - S Noe
- Medizinisches Versorgungszentrum am Karlsplatz, HIV Clinical Care and Research Center , Munich, Germany
| | - D Bongiovanni
- Department of Medicine I, Technical University of Munich, School of Medicine, University Hospital Klinikum rechts der Isar , Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance , Munich, Germany
| | - B Haller
- School of Medicine, Institute for Medical Informatics, Statistics and Epidemiology, Technical University of Munich , Munich, Germany
| | - C D Spinner
- Department of Medicine II, Technical University of Munich, School of Medicine, University Hospital Klinikum rechts der Isar , Munich, Germany.,DZIF (German Center for Infection Research), partner site Munich , Munich, Germany
| | - I Bernlochner
- Department of Medicine I, Technical University of Munich, School of Medicine, University Hospital Klinikum rechts der Isar , Munich, Germany
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18
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Dhir S, Dhir A. Cardiovascular Risk Assessment for Noncardiac Surgery: Are We Ready for Biomarkers? J Cardiothorac Vasc Anesth 2019; 34:1914-1924. [PMID: 31866221 DOI: 10.1053/j.jvca.2019.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 09/07/2019] [Accepted: 10/04/2019] [Indexed: 02/07/2023]
Abstract
Biomarkers aided perioperative cardiac assessment is a relatively new concept. Cardiac biomarkers with historical significance (aspartate transaminase, dehydrogenase, creatinine kinase and myoglobin) have paved the way for traditional biomarkers (cardiac troponin, C-reactive protein, lipoprotein). Contemporary biomarkers like natriuretic peptides (BNP and ProBNP) are validated risk markers in both acute and chronic cardiac diseases and are showing remarkable promise in predicting serious cardiovascular complications after non-cardiac surgery. This review is intended to provide a critical overview of traditional and contemporary biomarkers for perioperative cardiovascular assessment and management. This review also discusses the potential utility of newer biomarkers like galectin-3, sST-2, GDF-15, TNF-alpha, MiRNAs and many others that can predict inflammation, cardiac remodeling, injury and endogenous stress and need further investigations to establish their clinical utility. Though promising, biomarker led perioperative care is still in infancy and it has not been determined that it can improve clinical outcomes.
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Affiliation(s)
- Shalini Dhir
- Department of Anesthesia and Perioperative Medicine, Western University, London, Ontario, Canada.
| | - Achal Dhir
- Department of Anesthesia and Perioperative Medicine, Western University, London, Ontario, Canada
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19
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Vourc'h M, Senage T, Lepoivre T, Volteau C, Fortuit C, Pattier S, Guimbretiere G, Roussel JC, Rozec B. Romiplostim as a transfusion saving strategy in 20 patients after heart or lung transplantation: a single centre before-after pilot study. Perfusion 2019; 35:121-130. [PMID: 31359829 DOI: 10.1177/0267659119864814] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Thrombocytopenia is a common disorder after heart or lung transplantation. Platelet transfusion is often required to maintain haemostasis but represents a specific cause of morbidity and mortality in this setting including alloimmunisation and graft rejection. STUDY DESIGN AND METHODS As part of a health-care quality improvement project, in a single-centre before-after pilot study, the relevance of a platelet transfusion saving strategy based on romiplostim administration after transplantation was assessed in patients with platelet count <100 × 109/L. Transfusions on days 28 and 90 were compared using propensity matched score for adjustment of demographic characteristics at baseline. The primary outcome was platelet transfusion until day 28 after transplantation. RESULTS Ninety-three patients were analysed (73 before vs. 20 after). The median [interquartile range] number of platelet concentrate was 1 [0;4.0] before versus 0.5 [0;2.0] in the after period, mean difference 0.5 confidence interval 95% [-0.7 to 1.7], p = 0.39. On day 28, median [interquartile range] red blood cell transfusion was significantly higher in the before versus the after period, 7 [2.0;13.5] versus 6 [1.5;8.5], mean difference 3.2 CI 95% [0.4-6.0], p = 0.02. At 6 months, the rate of patients with de novo anti-human leukocyte antigen alloimmunisation was 45% before versus 53% in the after period (p = 0.56). Deep venous thrombosis was detected in nine patients (12%) before versus seven patients (35%) in the after period (p = 0.04). CONCLUSION Romiplostim did not significantly reduce platelet transfusion after heart or lung transplantation. Its relevance and safety in a global transfusion strategy remains to be studied in this setting in a large randomised study.
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Affiliation(s)
- Mickael Vourc'h
- Intensive Care Unit of Cardiothoracic Surgery, Anesthesia and Critical Care Department, Hôpital Nord Laennec, Nantes University Hospital, Nantes, France.,School of Medicine, UPRES EA 3826, Thérapeutiques Cliniques et Expérimentales des Infections, IRS2 Nantes Biotech, France
| | - Thomas Senage
- Department of Thoracic and Cardiovascular Surgery, Nantes University Hospital, Nantes, France
| | - Thierry Lepoivre
- Intensive Care Unit of Cardiothoracic Surgery, Anesthesia and Critical Care Department, Hôpital Nord Laennec, Nantes University Hospital, Nantes, France
| | - Christelle Volteau
- Biometry Platform, Research Promotion Department, Nantes University Hospital, Nantes, France
| | - Camille Fortuit
- Intensive Care Unit of Cardiothoracic Surgery, Anesthesia and Critical Care Department, Hôpital Nord Laennec, Nantes University Hospital, Nantes, France
| | - Sabine Pattier
- Department of Cardiology, Hôpital Nord Laennec, Nantes University Hospital, Nantes, France
| | - Guillaume Guimbretiere
- Department of Thoracic and Cardiovascular Surgery, Nantes University Hospital, Nantes, France
| | - Jean-Christian Roussel
- Department of Thoracic and Cardiovascular Surgery, Nantes University Hospital, Nantes, France
| | - Bertrand Rozec
- Intensive Care Unit of Cardiothoracic Surgery, Anesthesia and Critical Care Department, Hôpital Nord Laennec, Nantes University Hospital, Nantes, France
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20
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Imperiali CE, Arbiol-Roca A, Sanchez-Navarro L, Dastis-Arias M, Lopez-Delgado JC, Cortes-Bosch A, Sancho-Cerro A, Dot-Bach D. Reference interval for immature platelet fraction on Sysmex XN haematology analyser in adult population. Biochem Med (Zagreb) 2019; 28:010708. [PMID: 29472803 PMCID: PMC5812701 DOI: 10.11613/bm.2018.010708] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 01/07/2018] [Indexed: 02/05/2023] Open
Abstract
Introduction The Sysmex XN-series haematology analyser has newly adopted a fluorescent channel to measure immature platelet fraction (IPF). To promote the clinical utility of this promising parameter, establishing a reliable reference interval is mandatory. According to previous studies, IPF values may be affected by the employed analyser and the ethnic background of the individual, but no differences seem to be found between individuals’ genders. Therefore, this study aimed to define the reference interval for IPF in a Spanish population following Clinical and Laboratory Standard Institute (CLSI) guidelines. Materials and methods A total of 153 healthy Caucasian adults from Spain met the inclusion criteria. IPF measurement was performed by means of a Sysmex XN-2000 haematology analyser. A non-parametric percentile method was used to calculate the reference intervals in accordance with CLSI guidelines. Results The obtained reference interval for IPF on the Sysmex XN-2000 was 1.6–9.6% (90% confidence intervals (CIs) were 1.5–1.8 and 9.3–11.5, respectively). No significant gender difference in IPF reference intervals was observed (P = 0.101). Conclusions This study provides, for the first time, a reference interval for IPF using a Sysmex XN-2000 in a Spanish population, ranging from 1.6 to 9.6%. These data are needed to evaluate platelet production in several conditions such as thrombocytopenia, inflammatory states and cardiovascular diseases, as well as for future research.
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Affiliation(s)
- Claudia E Imperiali
- Clinical Laboratory, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ariadna Arbiol-Roca
- Clinical Laboratory, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Lourdes Sanchez-Navarro
- Clinical Laboratory, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Macarena Dastis-Arias
- Clinical Laboratory, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Juan C Lopez-Delgado
- Critical Care Unit, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Anna Cortes-Bosch
- Clinical Laboratory, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ana Sancho-Cerro
- Clinical Laboratory, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Dolors Dot-Bach
- Clinical Laboratory, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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21
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Koupenova M, Ravid K. Biology of Platelet Purinergic Receptors and Implications for Platelet Heterogeneity. Front Pharmacol 2018; 9:37. [PMID: 29441021 PMCID: PMC5797577 DOI: 10.3389/fphar.2018.00037] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/12/2018] [Indexed: 12/29/2022] Open
Abstract
Platelets are small anucleated cells present only in mammals. Platelets mediate intravascular hemostatic balance, prevent interstitial bleeding, and have a major role in thrombosis. Activation of platelet purinergic receptors is instrumental in initiation of hemostasis and formation of the hemostatic plug, although this activation process becomes problematic in pathological settings of thrombosis. This review briefly outlines the roles and function of currently known platelet purinergic receptors (P1 and P2) in the setting of hemostasis and thrombosis. Additionally, we discuss recent novel studies on purinergic receptor distribution according to heterogeneous platelet size, and the possible implication of this distribution on hemostatic function.
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Affiliation(s)
- Milka Koupenova
- Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Katya Ravid
- Departments of Medicine and Biochemistry and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, United States
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22
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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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