Increased platelet activation in early symptomatic versus asymptomatic carotid stenosis and relationship with microembolic status: Results from the Platelets And Carotid Stenosis (PACS) Study.

Hdl Handle:
http://hdl.handle.net/10147/292590
Title:
Increased platelet activation in early symptomatic versus asymptomatic carotid stenosis and relationship with microembolic status: Results from the Platelets And Carotid Stenosis (PACS) Study.
Authors:
Kinsella, Ja; Tobin, Wo; Tierney, S; Feeley, Tm; Egan, B; Collins, Dr; Coughlan, T; O'Neill, D; Harbison, J; Madhavan, P; Moore, Dj; O'Neill, Sm; Colgan, Mp; Doherty, Cp; Murphy, Rp; Saqqur, M; Moran, N; Hamilton, G; McCabe, Djh
Affiliation:
Departments of Neurology, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital, Trinity College Dublin, Ireland.
Citation:
Increased platelet activation in early symptomatic versus asymptomatic carotid stenosis and relationship with microembolic status: Results from the Platelets And Carotid Stenosis (PACS) Study. 2013: J. Thromb. Haemost.
Journal:
Journal of thrombosis and haemostasis : JTH
Issue Date:
26-Apr-2013
URI:
http://hdl.handle.net/10147/292590
DOI:
10.1111/jth.12277
PubMed ID:
23621656
Abstract:
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 versus 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 versus 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 hour 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 followed up to the late phase after symptom onset. The median platelet count (211 vs. 200 x 10(9) /L; p=0.03) and the median% lymphocyte-platelet complexes were higher in early symptomatic than asymptomatic patients (2.8 vs. 2.4%, p=0.001). The% lymphocyte-platelet complexes was higher in early symptomatic than asymptomatic patients with ≥70% carotid stenosis (p=0.0005), and in symptomatic patients recruited within 7 days of symptom onset (p=0.028). Complete TCD data were available in 25 asymptomatic and 31 early phase symptomatic, and 27 late phase symptomatic patients. 12% of asymptomatic versus 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% lymphocyte-platelet complexes than asymptomatic MES-negative patients (2.8 vs. 2.3%; p=0.0085). DISCUSSION: Recently symptomatic carotid stenosis patients have higher platelet counts (potentially reflecting increased platelet production, mobilisation 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. This article is protected by copyright. All rights reserved.
Item Type:
Article
Language:
en
ISSN:
1538-7836

Full metadata record

DC FieldValue Language
dc.contributor.authorKinsella, Jaen_GB
dc.contributor.authorTobin, Woen_GB
dc.contributor.authorTierney, Sen_GB
dc.contributor.authorFeeley, Tmen_GB
dc.contributor.authorEgan, Ben_GB
dc.contributor.authorCollins, Dren_GB
dc.contributor.authorCoughlan, Ten_GB
dc.contributor.authorO'Neill, Den_GB
dc.contributor.authorHarbison, Jen_GB
dc.contributor.authorMadhavan, Pen_GB
dc.contributor.authorMoore, Djen_GB
dc.contributor.authorO'Neill, Smen_GB
dc.contributor.authorColgan, Mpen_GB
dc.contributor.authorDoherty, Cpen_GB
dc.contributor.authorMurphy, Rpen_GB
dc.contributor.authorSaqqur, Men_GB
dc.contributor.authorMoran, Nen_GB
dc.contributor.authorHamilton, Gen_GB
dc.contributor.authorMcCabe, Djhen_GB
dc.date.accessioned2013-05-21T14:50:44Z-
dc.date.available2013-05-21T14:50:44Z-
dc.date.issued2013-04-26-
dc.identifier.citationIncreased platelet activation in early symptomatic versus asymptomatic carotid stenosis and relationship with microembolic status: Results from the Platelets And Carotid Stenosis (PACS) Study. 2013: J. Thromb. Haemost.en_GB
dc.identifier.issn1538-7836-
dc.identifier.pmid23621656-
dc.identifier.doi10.1111/jth.12277-
dc.identifier.urihttp://hdl.handle.net/10147/292590-
dc.description.abstractBACKGROUND: 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 versus 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 versus 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 hour 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 followed up to the late phase after symptom onset. The median platelet count (211 vs. 200 x 10(9) /L; p=0.03) and the median% lymphocyte-platelet complexes were higher in early symptomatic than asymptomatic patients (2.8 vs. 2.4%, p=0.001). The% lymphocyte-platelet complexes was higher in early symptomatic than asymptomatic patients with ≥70% carotid stenosis (p=0.0005), and in symptomatic patients recruited within 7 days of symptom onset (p=0.028). Complete TCD data were available in 25 asymptomatic and 31 early phase symptomatic, and 27 late phase symptomatic patients. 12% of asymptomatic versus 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% lymphocyte-platelet complexes than asymptomatic MES-negative patients (2.8 vs. 2.3%; p=0.0085). DISCUSSION: Recently symptomatic carotid stenosis patients have higher platelet counts (potentially reflecting increased platelet production, mobilisation 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. This article is protected by copyright. All rights reserved.en_GB
dc.languageENG-
dc.language.isoenen
dc.rightsArchived with thanks to Journal of thrombosis and haemostasis : JTHen_GB
dc.titleIncreased platelet activation in early symptomatic versus asymptomatic carotid stenosis and relationship with microembolic status: Results from the Platelets And Carotid Stenosis (PACS) Study.en_GB
dc.typeArticleen
dc.contributor.departmentDepartments of Neurology, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital, Trinity College Dublin, Ireland.en_GB
dc.identifier.journalJournal of thrombosis and haemostasis : JTHen_GB
dc.description.provinceLeinsteren

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