Study of platelet count and platelet volume indices in the spectrum of coronary artery diseases and its clinicopathological correlation

Biswajit Majumder; Himanshu Jain; Sharmistha Chatterjee; Tushar Kanti Das

doi:10.4103/njc.njc_9_17

ORIGINAL ARTICLE

Year : 2018 | Volume : 15 | Issue : 1 | Page : 63-66

Study of platelet count and platelet volume indices in the spectrum of coronary artery diseases and its clinicopathological correlation

Biswajit Majumder¹, Himanshu Jain², Sharmistha Chatterjee³, Tushar Kanti Das²
¹ Department of Cardiology, R G Kar Medical College, Kolkata, West Bengal, India
² Department of Pathology, R G Kar Medical College, Kolkata, West Bengal, India
³ Department of Biochemistry, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India

Date of Web Publication

7-May-2018

Correspondence Address:
Dr. Biswajit Majumder
181B/1 Kabiguru Sarani, Kolkata - 700 038, West Bengal
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/njc.njc_9_17

Abstract

Introduction: Larger platelets are enzymatically and metabolically more active and have higher thrombotic ability compared to the smaller one. The mean platelet volume (MPV) and other platelet volume indices quantification have been appreciated as biomarker of cardiovascular disease.
Aims and Objectives: To determine the platelet count, the various platelet volume indices and and to evaluate any statistical difference between these values among the patients of acute myocardial infarction (AMI), unstable and stable angina in age and sex matched control group.
Materials and Methods: 35 cases of AMI/unstable angina, 35 cases of stable angina were compared with 35 non cardiac patients with respect to platelet counts, MPV, PDW and PCT. All the parameters were measured as per standard protocol. Patients with bleeding disorder, thrombocytopenia, liver and kidney disease were excluded.
Result and Analysis: In our study MPV and mean PDW were significantly higher in acute myocardial infarction/unstable angina patients than stable angina (P < 0.05). Statistically significant higher PDW and MPV were also observed in AMI/UA patients than control subjects (P < 0.05).
Conclusion: Measurement of platelet count and platelet volume indices may be of some benefit in detecting those patients at higher risk of an acute coronary syndrome.

Keywords: Coronary artery, disease, platelet, volume indices

How to cite this article:
Majumder B, Jain H, Chatterjee S, Das TK. Study of platelet count and platelet volume indices in the spectrum of coronary artery diseases and its clinicopathological correlation. Nig J Cardiol 2018;15:63-6

How to cite this URL:
Majumder B, Jain H, Chatterjee S, Das TK. Study of platelet count and platelet volume indices in the spectrum of coronary artery diseases and its clinicopathological correlation. Nig J Cardiol [serial online] 2018 [cited 2022 Aug 19];15:63-6. Available from: https://www.nigjcardiol.org/text.asp?2018/15/1/63/231977

Introduction

Coronary artery disease (CAD) is an epidemic and is the most common cause of mortality worldwide. Majority of deaths from CAD result from acute coronary syndrome because of rupture or fissuring of an unstable atherosclerotic plaque accompanied by a cascade of platelet reactions, resulting in thrombus formation. The overwhelming importance of platelets in vascular hemostasis and pathogenesis in acute coronary syndrome has triggered plenty of research activities toward understanding of the platelet physiology, function, and the development of antiplatelet drugs. Larger platelets are enzymatically and metabolically more active and have higher thrombotic ability compared to the smaller one.^[1],[2],[3] The mean platelet volume (MPV) and other platelet volume indices' quantification have been appreciated as a biomarker of cardiovascular disease.^[4],[5],[6] Compared with healthy controls, increased MPV, platelet distribution width (PDW), platelet large cell ratio (P-LCR), and decreased plateletcrit (PCT) are seen in patients with known CAD risk factors such as smoking, diabetes mellitus, and hypertension.^{[7],[8],[9],[10]} MPV is known to be higher in patients with unstable angina (UA) compared to stable angina patients.^{[10],[11],[12],[13]} In the light of this background, we undertook this study to investigate any possible relation between the various platelet indices and acute myocardial infarction (AMI) and stable and UA.

Aims and objectives

To determine the platelet count, the various platelet volume indices and to evaluate any statistical difference between these values among the patients of AMI, UA, and stable angina in age- and sex-matched control group.

Materials and Methods

The study was conducted in the Department of Cardiology and Pathology, R G Kar Medical College from April 2015 to March 2016. Thirty-five cases of AMI/UA and 35 cases of stable angina were compared with 35 noncardiac patients with respect to platelet counts, MPV, PDW, and PCT. All the parameters were measured as per standard protocol. Patients with bleeding disorder, thrombocytopenia, and liver and kidney disease were excluded from the study.

The study population was divided into three groups:

Group 1: Patients with AMI/UA – 35 cases
Group 2: Patients with chronic stable angina – 35 cases
Group 3: Healthy controls – 35 cases.

Results and Analysis

The data obtained from the study were compiled and statistically analyzed by Kruskal–Wallis test (nonparametric K-independent sample test) using SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. (Chicago, SPSS Inc.).

In Group 1, 25 (71%) patients were of AMI and 10 (29%) patients were of UA.

The mean age of all selected patients was 61.30 ± 10.48 years with range from 40 to 84 years. The mean age in Groups 1–3 was 59.49 ± 12.02, 62.40 ± 9.22, and 62.03 ± 10.48, respectively. Out of 105 patients, 57 (54%) were males and 48 (46%) were females. In Groups 1 and 3, 20 (57%) patients were males and 15 (43%) were females. In Group 2, 17 (49%) were males and 18 (51%) were females. The mean platelet count in all randomly selected cases was 216.80 ± 105.36 × 10³/cmm. The mean platelet count of Group 1 (177.20 ± 73.22 × 10³/cmm) was significantly lower than Group 2 (228.40 ± 106.30 × 10³/cmm). The mean platelet count of Group 2 was also lower than Group 3 (244.80 ± 121.38 × 10³/cmm). No significant difference was noted between the mean platelet count of male and female patients [Table 1]. The MPV of all randomly selected patients was 11.24 ± 1.41fl. The MPV of Group 1 (11.99 ± 1.62fl) was significantly higher than Group 2 (10.93 ± 1.22fl). The MPV of Group 2 was also higher than Group 3 (10.80 ± 1.05). The difference of MPV between Group 2 and Group 3 was statistically nonsignificant [Table 2]. The PDW of all patients was 15.69 ± 3.85%. The PDW of Group 1 (18.20 ± 3.87%) was significantly higher than Group 2 (14.73 ± 3.69%) and control Group 3 (14.14 ± 2.63%). The PDW of Group 2 was higher than Group 3, but it was not statistically significant. The mean PDW among females (16.15 ± 3.85%) was higher than in males (15.30 ± 3.85%) [Table 3]. The mean P-LCR of all patients was 36.58 ± 10.11%. The mean P-LCR of Group 3 (31.73 ± 7.13) was significantly lower than Group 1 (42.62 ± 9.17%) and Group 2 (35.38 ± 10.69%) [Table 4]. The mean PCT of all patients was 0.23 ± 0.13%. The PCT of Group 1 (0.18 ± 0.10%) was significantly lower than that of Group 2 (0.25 ± 0.14%) and control Group 3 (0.23 ± 0.13%). The difference of PCT in Group 2 and Group 3 was not statistically significant [Table 5]. The PCT of females was slightly higher than males.

Table 1: Comparison of platelet count in each groups

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Table 2: Distribution of mean platelet volume according to group

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Table 3: Distribution of platelet distribution width according to group

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Table 4: Distribution of platelet large cell ratio according to group

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Table 5: Distribution of plateletcrit according to group

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Discussion

In our study, MPV and mean PDW were significantly higher in AMI/UA patients than stable angina and statistically significant higher PDW and MPV were also observed in AMI/UA patients than controls. Our results are similar to that of Khandekar et al., who also showed higher MPV and mean PDW in AMI or UA patients than stable CAD.

The mean P-LCR was significantly lower in stable angina patients compared to AMI/UA patients. Statistically significant lower P-LCR was also observed in controls compared to AMI/UA patients. We did not find any significant association of mean P-LCR in patients with stable angina and healthy control group. Our results are comparable to study of Khandekar et al. and Manchanda et al.

The mean PCT was significantly lower in AMI/UA patients than stable angina. Statistically significant lower PCT was also observed in AMI/UA patients compared to healthy control groups. We did not find any statistically significant association of mean PCT in patients with stable angina and healthy control. Results are similar to other published studies.^{[14],[15],[16],[17]}

This study showed significantly lower platelet counts and lower PCT in AMI/UA patients in comparison to stable angina patients. Our study shows increased platelet volume indices, i.e., (MPV, PDW, and P-LCR) in AMI/UA patients than stable angina patients and healthy controls. Activation of platelets occurs before acute coronary syndrome and consumption of platelets at ruptured atherosclerotic plaque site probably release larger sized platelets from bone marrow. Although some studies have shown higher MPV in patients with UA than AMI, we found no such difference in our study like Senaran et al. Although in our study we have found higher values of MPV, PWD, P-LCR in patients with UA and AMI compared to stable angina, majority of other studies showed stronger correlation of higher MPV rather than PDW and P-LCR in patients with UA/AMI compared to stable angina. However, there is certain limitation of our studies. The sample size of our study was low. The MPV is influenced by many factors such as ethnicity, medication, illness, obesity, smoking, aging, diabetes, aspirin, clopidogrel, and inflammatory bowel disease.^{[18],[19],[20],[21]} The majority of patients in Groups 1 and 2 were getting aspirin and clopidogrel which may interfere with the determination of MPV. MPV is a simple and economic laboratory measurement and it might be very useful in conjunction with other conventional biochemical cardiac markers in the early prediction of acute coronary syndrome in high-risk patients. However, it should be substantiated with further well-designed studies.

Conclusion

Hence, it can be concluded from our study that larger platelets are hemostatically active and act as risk factors for developing coronary thrombosis leading to myocardial infarction. Platelet count and platelet volume indices can provide a signature for the prethrombotic state in ischemic heart disease. Measurement of platelet count and platelet volume indices may be of some benefit in detecting those patients at higher risk of acute coronary syndrome.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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