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      Value of serial platelet indices measurements for the prediction of pulmonary embolism in patients with deep venous thrombosis.

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          Abstract

          To date, no validated biomarkers with high sensitivity and specificity have been established for diagnosis of pulmonary embolism (PE) in patients with deep venous thrombosis (DVT). There is a need to develop simple and reliable noninvasive tests that can accurately identify patients with PE, even in small hospitals or clinics. The aim of this study was to investigate the value of mean platelet volume (MPV) and platelet distribution width (PDW) for predicting occurrence of PE in patients with DVT.

          Most cited references26

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          Mean platelet volume as a predictor of cardiovascular risk: a systematic review and meta-analysis.

          To determine whether an association exists between mean platelet volume (MPV) and acute myocardial infarction (AMI) and other cardiovascular events. Platelet activity is a major culprit in atherothrombotic events. MPV, which is widely available in clinical practice, is a potentially useful biomarker of platelet activity in the setting of cardiovascular disease. We performed a systematic review and meta-analysis investigating the association between MPV and AMI, all-cause mortality following myocardial infarction, and restenosis following coronary angioplasty. Results were pooled using random-effects modeling. Pooled results from 16 cross-sectional studies involving 2809 patients investigating the association of MPV and AMI indicated that MPV was significantly higher in those with AMI than those without AMI [mean difference 0.92 fL, 95% confidence interval (CI) 0.67-1.16, P < 0.001). In subgroup analyses, significant differences in MPV existed between subjects with AMI, subjects with stable coronary disease (P < 0.001), and stable controls (P < 0.001), but not vs. those with unstable angina (P = 0.24). Pooled results from three cohort studies involving 3184 patients evaluating the risk of death following AMI demonstrated that an elevated MPV increased the odds of death as compared with a normal MPV (11.5% vs. 7.1%, odds ratio 1.65, 95% CI 1.12-2.52, P = 0.012). Pooled results from five cohort studies involving 430 patients who underwent coronary angioplasty revealed that MPV was significantly higher in patients who developed restenosis than in those who did not develop restenosis (mean difference 0.98 fL, 95% CI 0.74-1.21, P < 0.001). Elevated MPV is associated with AMI, mortality following myocardial infarction, and restenosis following coronary angioplasty. These data suggest that MPV is a potentially useful prognostic biomarker in patients with cardiovascular disease. Whether the relationship is causal, and whether MPV should influence practice or guide therapy, remains unknown.
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            Platelet size: measurement, physiology and vascular disease.

            Platelet volume is a marker of platelet function and activation. It is readily measured as mean platelet volume (MPV) by clinical haematology analysers using sodium citrate as the anticoagulant. Measurement in EDTA can be unreliable since MPV increases significantly in a time-dependent manner. MPV correlates with platelet function and activation, whether measured as aggregation, thromboxane synthesis, beta-thromboglobulin release, procoagulant function, or adhesion molecule expression. MPV is increased in certain vascular risk factor states, including hypercholesterolaemia and diabetes mellitus, but not essential hypertension. It is increased in acute myocardial infarction, acute ischaemic stroke, pre-eclampsia and renal artery stenosis. Importantly, an elevated MPV predicts a poor outcome following myocardial infarction, restenosis following coronary angioplasty, and the development of pre-eclampsia. Research into the epidemiology of MPV is now required to determine whether thrombomegaly is a risk factor for developing vascular disease. Similarly, the physiological mechanisms which regulate MPV within the megakaryocyte need to be elucidated. Whether MPV ever becomes a routinely requested test remains to be seen but changes in methodology will be required first.
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              Platelet distribution width: a simple, practical and specific marker of activation of coagulation.

              Platelet indices are potentially useful markers for the early diagnosis of thromboembolic diseases. An increase in both mean platelet volume (MPV) and platelet distribution width (PDW) due to platelet activation, resulting from platelet swelling and pseudopodia formation was hypothesized. Platelet indices (MPV and PDW) in three groups of persons, using impedance and optical technology were measured. The first group consisted of patients with established platelet activation and healthy control subjects. The second study group included pregnant women in different trimesters of pregnancy. The effect of storage time on MPV and PDW in blood samples of a third group of randomly chosen patients was also assessed. There was a significant increase in MPV (P<0.001) and PDW (P<0.001) in patients with confirmed platelet activation compared to healthy control subjects. Only PDW showed a significant increase from the first to the third trimester of pregnancy (P=0.009). Temporal changes of MPV and PDW over storage time revealed a significant increase in MPV (P<0.001), in contrast to a significant decrease in PDW (P<0.05). MPV and PDW are simple platelet indices, which increase during platelet activation. PDW is a more specific marker of platelet activation, since it does not increase during simple platelet swelling.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Therapeutics and clinical risk management
                Informa UK Limited
                1176-6336
                1176-6336
                2015
                : 11
                Affiliations
                [1 ] Department of Cardiovascular Surgery, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey.
                [2 ] Department of General Surgery, Dicle University, Diyarbakir, Turkey.
                [3 ] Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey.
                [4 ] Department of General Surgery, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey.
                [5 ] Department of Cardiovascular Surgery, Liv Hospital, Ankara, Turkey.
                Article
                tcrm-11-1243
                10.2147/TCRM.S89355
                4548763
                26316769
                9532ea62-c8ea-4eac-8bc0-5f6edeae8477
                History

                deep venous thrombosis,mean platelet volume,platelet distribution width,platelet indices,pulmonary embolism

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