Increased platelet counts and platelet activation in early sympto.pdf (351.55 kB)
Download file

Increased platelet counts and platelet activation in early symptomatic versus asymptomatic carotid stenosis and relationship with microembolic status: results from the platelets and carotid stenosis (PACS) study

Download (351.55 kB)
journal contribution
posted on 11.05.2022, 13:53 authored by Justin A. Kinsella, W Oliver Tobin, Sean Tierney, Timothy M. Feeley, Bridget Egan, Daniel R. Collins, Tara Coughlan, Desmond O'Neill, Joseph Harbison, Prakash Madhavan, Dermot J. Moore, Sean M. O'Neill, Mary P. Colgan, Colin P. Doherty, Raymond P. Murphy, Maher Saqqur, Niamh MoranNiamh Moran, George Hamilton, D JH McCabe

 

Background: Cerebral microembolic signals (MES) may predict increased stroke risk in carotid stenosis. However, the relationship between platelet counts or platelet activation status and MES in symptomatic vs. asymptomatic carotid stenosis has not been comprehensively assessed.

Setting: University teaching hospitals.

Methods: This prospective, pilot observational study assessed platelet counts and platelet activation status, and the relationship between platelet activation and MES in asymptomatic vs. early (≤ 4 weeks after TIA/stroke) and late phase (≥ 3 months) symptomatic moderate or severe (≥ 50%) carotid stenosis patients. Full blood count measurements were performed, and whole blood flow cytometry was used to quantify platelet surface activation marker expression (CD62P and CD63) and circulating leucocyte-platelet complexes. Bilateral simultaneous transcranial Doppler ultrasound monitoring of the middle cerebral arteries was performed for 1 h to classify patients as MES positive or MES negative.

Results: Data from 31 asymptomatic patients were compared with 46 symptomatic patients in the early phase, and 35 of these patients were followed up to the late phase after symptom onset. The median platelet count (211 vs. 200 × 10(9) L(-1) ; P = 0.03) and the median percentage of lymphocyte-platelet complexes was higher in early symptomatic than asymptomatic patients (2.8 vs. 2.4%; P = 0.001). The percentage of lymphocyte-platelet complexes was higher in early symptomatic than in asymptomatic patients with ≥ 70% carotid stenosis (P = 0.0005) and symptomatic patients recruited within 7 days of symptom onset (P = 0.028). Complete TCD data were available in 25 asymptomatic, 31 early phase symptomatic and 27 late phase symptomatic patients. Twelve per cent of asymptomatic vs. 32% of early phase symptomatic (P = 0.02) and 19% of late phase symptomatic patients (P = 0.2) were MES positive. Early symptomatic MES-negative patients had a higher percentage of lymphocyte-platelet complexes than asymptomatic MES-negative patients (2.8 vs. 2.3%; P = 0.0085).

Discussion: Recently, symptomatic carotid stenosis patients have had higher platelet counts (potentially reflecting increased platelet production, mobilization or reduced clearance) and platelet activation status than asymptomatic patients. MES were more frequently detected in early symptomatic than asymptomatic patients, but the differences between late symptomatic and asymptomatic groups were not significant. Increased lymphocyte-platelet complex formation in recently symptomatic vs. asymptomatic MES-negative patients indicates enhanced platelet activation in this early symptomatic subgroup. Platelet biomarkers, in combination with TCD, have the potential to aid risk-stratification in asymptomatic and symptomatic carotid stenosis patients.

Funding

Stanley Thomas Johnson Foundation

Bayer Schering Ireland

Pfizer Ireland

Sanofi Aventis Ireland

Elitech UK

IICN-Serono Fellowship, Meath Foundation, Lundbeck Neurosciences Bursary programme

Merck Serono Ireland

Brennan and Company, Ireland

Biogen Idec Ireland Limited

Programme for Research in Third Level Institutions in Ireland (Cycle 4), co-funded by the European Regional Development Fund

History

Comments

This is the peer reviewed version of the following article:, Kinsella JA. et al. Increased platelet activation in early symptomatic vs. asymptomatic carotid stenosis and relationship with microembolic status: results from the Platelets and Carotid Stenosis Study. J Thromb Haemost. 2013;11(7):1407-16, which has been published in final form at doi: 10.1111/jth.12277. PMID: 23621656. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.

Published Citation

Kinsella JA. et al. Increased platelet activation in early symptomatic vs. asymptomatic carotid stenosis and relationship with microembolic status: results from the Platelets and Carotid Stenosis Study. J Thromb Haemost. 2013;11(7):1407-16.

Publication Date

26 April 2013

PubMed ID

23621656

Department/Unit

  • School of Pharmacy and Biomolecular Sciences

Publisher

Wiley

Version

  • Accepted Version (Postprint)