http://informahealthcare.com/plt ISSN: 0953-7104 (print), 1369-1635 (electronic) Platelets, 2015; 26(3): 269–270 ! 2013 Informa UK Ltd. DOI: 10.3109/09537104.2013.842207
LETTER TO THE EDITOR
Mean platelet volume in patients undergoing percutaneous coronary intervention Sevket Balta1, Dimitri P. Mikhailidis2, Ertugrul Kurtoglu3, & Sait Demirkol1 1
Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey, 2Department of Clinical Biochemistry, Medical School London, University College London (UCL), London, UK, and 3Department of Cardiology, Elazig Education and Research Hospital, Elazig, Turkey
To the editor, We read with interest the article entitled ‘‘Clinical outcome prediction from mean platelet volume (MPV) in patients undergoing percutaneous coronary intervention (PCI) in Korean cohort: Implications of more simple and useful test than platelet function testing’’ by Choi et al. [1]. In that important study, MPV was a predictor of cardiac death after PCI; the association between risk and MPV was stronger in those with acute coronary syndromes (ACS). A complete blood count is a relatively routine and inexpensive test that includes the MPV [2, 3]. Platelets might contribute to the pathogenesis ACS [4], the risk of re-infarction [5] and prognosis after acute myocardial infarction and PCI [6]. Platelet function can also be affected by vascular risk factors including age, smoking, diabetes mellitus, hypertension, hyperlipidemia, metabolic syndrome and obesity as well as by deep vein thrombosis [7, 8]. The MPV can decrease significantly after rosuvastatin treatment [9]. In this context, we note the significant difference in statin loading between the two MPV groups in the Choi et al. study [1, Table 1]. This may have affected the results, especially since dyslipidemia was the most significant variable in multivariate analysis in their study [1, Table 1]. There is also a difference in drug-eluting stents between these groups. The MPV has also been related to peripheral artery disease, atrial fibrillation [10], previous surgical history, trauma, cancer, immobilization, ulcerative colitis, celiac disease and some medications [11, 12]. Inflammation plays a role in the pathogenesis of many diseases such as Behc¸et’s disease where MPV changes may occur [13]. Obstructive sleep apnea syndrome may be associated with increased cardiovascular morbidity and mortality, platelet activation and increased MPV [14]. Non-alcoholic fatty liver disease (NAFLD) may be associated with cardiovascular risk. After controlling for factors associated with NAFLD, there was a significant correlation between MPV and NAFLD [8]. In conclusion, the MPV may be affected by many factors that need to be considered. It is difficult to adjust for all the variables listed above. Finally, standardized laboratory methods are essential. Venous blood samples were collected in potassium ethylene diamine tetraacetic acid (K2-EDTA) in this study [1]. Measurement in EDTA can be unreliable since MPV increases
Correspondence: Dr. Sevket Balta, Department of Cardiology, Gulhane School of Medicine, Tevfik Saglam St., 06018 Etlik-Ankara, Turkey. Tel: +90-312-3044281. Fax: +90-312-3044250. E-mail: drsevketb@ gmail.com
Keywords Mean platelet volume, NAFLD, percutaneous coronary intervention History Received 4 September 2013 Accepted 4 September 2013 Published online 31 October 2013
significantly in a time-dependent manner after collection [15]. Optimal measuring time should be 120 minutes after venipuncture because it is reliable for a reference range [16]. Because Choi et al. evaluated patients undergoing PCI retrospectively and they measured MPV levels within two hours after sample collection [1], they might not be able to accurately define how much time elapsed before each measurement of MPV; blood sampling time affects MPV measurements [17].
Declaration of interest There is no conflict of interests.
References 1. Choi S-W, Choi D-H, Kim H-W, Ku Y-H, Ha S-I, Park G. Clinical outcome prediction from mean platelet volume in patients undergoing percutaneous coronary intervention in Korean cohort: Implications of more simple and useful test than platelet function testing. Platelets 2013;7104:1–6. 2. Balta S, Demirkol S, Celik T, Kucuk U, Unlu M, Arslan Z, Balta I, Iyisoy A, Kocak N, Haqmal H, et al. Association between coronary artery ectasia and neutrophil-lymphocyte ratio. Angiology 2013. [Epub ahead of print]. 3. Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: A link between thrombosis and inflammation? Curr Pharm Des 2011;17:47–58. 4. Avramakis G, Papadimitraki E, Papakonstandinou D, Liakou K, Zidianakis M, Dermitzakis A, Mikhailidis DP, Ganotakis ES. Platelets and white blood cell subpopulations among patients with myocardial infarction and unstable angina. Platelets 2007;18: 16–23. 5. Ly HQ, Kirtane AJ, Murphy SA, Buros J, Cannon CP, Braunwald E, Gibson CM; TIMI Study Group. Association of platelet counts on presentation and clinical outcomes in ST-elevation myocardial infarction (from the TIMI Trials). Am J Cardiol 2006;98:1–5. 6. Balta S, Demirkol S, Celik T, Akgul EO. Mean platelet volume as a surrogate marker of long-term mortality in patients
270
7.
8. 9.
10. 11.
S. Balta et al. undergoing percutaneous coronary intervention. Am J Cardiol 2013; 112:142. Han JS, Park TS, Cho SY, Joh JH, Ahn HJ. Increased mean platelet volume and mean platelet volume/platelet count ratio in Korean patients with deep vein thrombosis. Platelets 2012. [Epub ahead of print]. Shin W-Y, Jung D-H, Shim J-Y, Lee H-R. The association between non-alcoholic hepatic steatosis and mean platelet volume in an obese Korean population. Platelets 2011;22:442–446. Coban E, Afacan B. The effect of rosuvastatin treatment on the mean platelet volume in patients with uncontrolled primary dyslipidemia with hypolipidemic diet treatment. Platelets 2008; 19:111–114. Balta S, Demirkol S, Kucuk U, Unlu M. Hemostatic markers can be pivotal roles of risk factors for new-onset atrial fibrillation. Platelets 2013. [Epub ahead of print]. Demirkol S, Balta S, Unlu M, Yuksel UC, Celik T, Arslan Z, Kucuk U, Yokusoglu M. Evaluation of the mean platelet volume in patients with cardiac syndrome X. Clinics (Sa˜o Paulo, Brazil) 2012; 67:1019–1022.
Platelets, 2015; 26(3): 269–270
12. Balta S, Demirkol S, Kucuk U, Unlu M. Hemostatic markers can be pivotal roles of risk factors for new-onset atrial fibrillation. Platelets 2013. [Epub ahead of print]. 13. Ekiz O, Balta I, Sen BB, Rifaioglu EN, Ergin C, Balta S, Demirkol S. Mean platelet volume in recurrent aphthous stomatitis and Behcet Disease. Angiology 2013. [Epub ahead of print]. 14. Nena E, Papanas N, Steiropoulos P, Zikidou P, Zarogoulidis P, Pita E, Constantinidis TC, Maltezos E, Mikhailidis DP, Bouros D. Mean platelet volume and platelet distribution width in non-diabetic subjects with obstructive sleep apnoea syndrome: New indices of severity? Platelets 2012;23:447–454. 15. Bath PM, Butterworth RJ. Platelet size: measurement, physiology and vascular disease. Blood Coagul Fibrinolysis 1996;7:157–161. 16. Lance´ MD, van Oerle R, Henskens YMC, Marcus MAE. Do we need time adjusted mean platelet volume measurements? Lab Hematol 2010;16:28–31. 17. Balta S, Demirkol S, Kucuk U, Arslan Z, Unlu M, Iyisoy A, Yokusoglu M. Mean platelet volume may be related to the degree of coronary collateral circulation. Eur Rev Med Pharmacol Sci 2013; 17:707–708.
Copyright of Platelets is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
LETTER TO THE EDITOR
Mean platelet volume in patients undergoing percutaneous coronary intervention Sevket Balta1, Dimitri P. Mikhailidis2, Ertugrul Kurtoglu3, & Sait Demirkol1 1
Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey, 2Department of Clinical Biochemistry, Medical School London, University College London (UCL), London, UK, and 3Department of Cardiology, Elazig Education and Research Hospital, Elazig, Turkey
To the editor, We read with interest the article entitled ‘‘Clinical outcome prediction from mean platelet volume (MPV) in patients undergoing percutaneous coronary intervention (PCI) in Korean cohort: Implications of more simple and useful test than platelet function testing’’ by Choi et al. [1]. In that important study, MPV was a predictor of cardiac death after PCI; the association between risk and MPV was stronger in those with acute coronary syndromes (ACS). A complete blood count is a relatively routine and inexpensive test that includes the MPV [2, 3]. Platelets might contribute to the pathogenesis ACS [4], the risk of re-infarction [5] and prognosis after acute myocardial infarction and PCI [6]. Platelet function can also be affected by vascular risk factors including age, smoking, diabetes mellitus, hypertension, hyperlipidemia, metabolic syndrome and obesity as well as by deep vein thrombosis [7, 8]. The MPV can decrease significantly after rosuvastatin treatment [9]. In this context, we note the significant difference in statin loading between the two MPV groups in the Choi et al. study [1, Table 1]. This may have affected the results, especially since dyslipidemia was the most significant variable in multivariate analysis in their study [1, Table 1]. There is also a difference in drug-eluting stents between these groups. The MPV has also been related to peripheral artery disease, atrial fibrillation [10], previous surgical history, trauma, cancer, immobilization, ulcerative colitis, celiac disease and some medications [11, 12]. Inflammation plays a role in the pathogenesis of many diseases such as Behc¸et’s disease where MPV changes may occur [13]. Obstructive sleep apnea syndrome may be associated with increased cardiovascular morbidity and mortality, platelet activation and increased MPV [14]. Non-alcoholic fatty liver disease (NAFLD) may be associated with cardiovascular risk. After controlling for factors associated with NAFLD, there was a significant correlation between MPV and NAFLD [8]. In conclusion, the MPV may be affected by many factors that need to be considered. It is difficult to adjust for all the variables listed above. Finally, standardized laboratory methods are essential. Venous blood samples were collected in potassium ethylene diamine tetraacetic acid (K2-EDTA) in this study [1]. Measurement in EDTA can be unreliable since MPV increases
Correspondence: Dr. Sevket Balta, Department of Cardiology, Gulhane School of Medicine, Tevfik Saglam St., 06018 Etlik-Ankara, Turkey. Tel: +90-312-3044281. Fax: +90-312-3044250. E-mail: drsevketb@ gmail.com
Keywords Mean platelet volume, NAFLD, percutaneous coronary intervention History Received 4 September 2013 Accepted 4 September 2013 Published online 31 October 2013
significantly in a time-dependent manner after collection [15]. Optimal measuring time should be 120 minutes after venipuncture because it is reliable for a reference range [16]. Because Choi et al. evaluated patients undergoing PCI retrospectively and they measured MPV levels within two hours after sample collection [1], they might not be able to accurately define how much time elapsed before each measurement of MPV; blood sampling time affects MPV measurements [17].
Declaration of interest There is no conflict of interests.
References 1. Choi S-W, Choi D-H, Kim H-W, Ku Y-H, Ha S-I, Park G. Clinical outcome prediction from mean platelet volume in patients undergoing percutaneous coronary intervention in Korean cohort: Implications of more simple and useful test than platelet function testing. Platelets 2013;7104:1–6. 2. Balta S, Demirkol S, Celik T, Kucuk U, Unlu M, Arslan Z, Balta I, Iyisoy A, Kocak N, Haqmal H, et al. Association between coronary artery ectasia and neutrophil-lymphocyte ratio. Angiology 2013. [Epub ahead of print]. 3. Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: A link between thrombosis and inflammation? Curr Pharm Des 2011;17:47–58. 4. Avramakis G, Papadimitraki E, Papakonstandinou D, Liakou K, Zidianakis M, Dermitzakis A, Mikhailidis DP, Ganotakis ES. Platelets and white blood cell subpopulations among patients with myocardial infarction and unstable angina. Platelets 2007;18: 16–23. 5. Ly HQ, Kirtane AJ, Murphy SA, Buros J, Cannon CP, Braunwald E, Gibson CM; TIMI Study Group. Association of platelet counts on presentation and clinical outcomes in ST-elevation myocardial infarction (from the TIMI Trials). Am J Cardiol 2006;98:1–5. 6. Balta S, Demirkol S, Celik T, Akgul EO. Mean platelet volume as a surrogate marker of long-term mortality in patients
270
7.
8. 9.
10. 11.
S. Balta et al. undergoing percutaneous coronary intervention. Am J Cardiol 2013; 112:142. Han JS, Park TS, Cho SY, Joh JH, Ahn HJ. Increased mean platelet volume and mean platelet volume/platelet count ratio in Korean patients with deep vein thrombosis. Platelets 2012. [Epub ahead of print]. Shin W-Y, Jung D-H, Shim J-Y, Lee H-R. The association between non-alcoholic hepatic steatosis and mean platelet volume in an obese Korean population. Platelets 2011;22:442–446. Coban E, Afacan B. The effect of rosuvastatin treatment on the mean platelet volume in patients with uncontrolled primary dyslipidemia with hypolipidemic diet treatment. Platelets 2008; 19:111–114. Balta S, Demirkol S, Kucuk U, Unlu M. Hemostatic markers can be pivotal roles of risk factors for new-onset atrial fibrillation. Platelets 2013. [Epub ahead of print]. Demirkol S, Balta S, Unlu M, Yuksel UC, Celik T, Arslan Z, Kucuk U, Yokusoglu M. Evaluation of the mean platelet volume in patients with cardiac syndrome X. Clinics (Sa˜o Paulo, Brazil) 2012; 67:1019–1022.
Platelets, 2015; 26(3): 269–270
12. Balta S, Demirkol S, Kucuk U, Unlu M. Hemostatic markers can be pivotal roles of risk factors for new-onset atrial fibrillation. Platelets 2013. [Epub ahead of print]. 13. Ekiz O, Balta I, Sen BB, Rifaioglu EN, Ergin C, Balta S, Demirkol S. Mean platelet volume in recurrent aphthous stomatitis and Behcet Disease. Angiology 2013. [Epub ahead of print]. 14. Nena E, Papanas N, Steiropoulos P, Zikidou P, Zarogoulidis P, Pita E, Constantinidis TC, Maltezos E, Mikhailidis DP, Bouros D. Mean platelet volume and platelet distribution width in non-diabetic subjects with obstructive sleep apnoea syndrome: New indices of severity? Platelets 2012;23:447–454. 15. Bath PM, Butterworth RJ. Platelet size: measurement, physiology and vascular disease. Blood Coagul Fibrinolysis 1996;7:157–161. 16. Lance´ MD, van Oerle R, Henskens YMC, Marcus MAE. Do we need time adjusted mean platelet volume measurements? Lab Hematol 2010;16:28–31. 17. Balta S, Demirkol S, Kucuk U, Arslan Z, Unlu M, Iyisoy A, Yokusoglu M. Mean platelet volume may be related to the degree of coronary collateral circulation. Eur Rev Med Pharmacol Sci 2013; 17:707–708.
Copyright of Platelets is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
