Increased mean platelet volume (MPV) is associated with platelet reactivity and is a predictor of cardiovascular risk and unprovoked venous thromboembolism. The aim of our study was to evaluate MPV in patients with confirmed antiphospholipid antibody syndrome (APS) and to identify the correlation between the value of MPV and the recurrence of thrombosis. The studied group consists of 247 patients with a history of thrombosis and/or pregnancy loss (median age 38, range 18–66 years) classified as APS group (n = 70) or APS negative patients (n = 177) according to the updated Sapporo criteria. The control group consisted of 98 healthy subjects. MPV was significantly higher in the group of patients with clinically and laboratory confirmed APS (median 7.85, range 4.73–12.2 fl) in comparison with the controls. It was also higher than in APS negative patients (7.61, range 5.21–12.3 fl). APS patients with triple positivity for antiphospholipid antibodies with respect to Miyakis classification categories had higher MPV values than other APS patients (9.69 ± 1.85 vs. 7.29 ± 1.3 fl, p = 0.001). Recurrent thrombotic episodes were observed in 83 patients, but among the triple positive high-risk patients with APS in 80 % cases (p = 0.0046). In receiver operating characteristic curve analysis, the value of MPV level for thrombosis recurrence prediction in the APS group with sensitivity of 86 % and specificity of 82 % was 7.4 fl. In the multivariate logistic regression model, MPV above 7.4 fl (OR 3.65; 95 % CI 1.38–9.64, p = 0.009) significantly predicts thrombosis recurrence. Our results identify the value of MPV as a prognostic factor of thrombosis recurrence in patients with APS.
INTROduCTION Acetylsalicylic acid (ASA) is a first-line drug used in ischemic stroke prophylaxis and therapy. Its partial effectiveness can be caused by the so-called resistance to ASA, which definition indicates to insufficient platelet activity inhibition, measured by aggregometry, platelet function analyzers (PFA-100, Ultegra RPFA, Pla-CorPRT), or flow cytometry. A precise definition based on platelet cyclooxygenase-1 (COX-1) activity maintenance is recommended. Constant thromboxane A 2 synthesis (TxA2) is probably the main mechanism of resistance to ASA. The causes of resistance to ASA involve decreased drug bio activity, drug misuse and its insufficient dose, simultaneous use of other anti-inflammatory drugs, increased platelet activity 1 and their increased formation. Hyperlipidemia, hypercoagulability and TxA2 bio synthesis with cyclooxygenase-2 (COX-2), cyclic superoxides, G 2 and H 2 prostaglandins (PGG 2 /PGH 2) migration from epithelial cells to platelets, and smoking, catecholaminemia, physical exercise, emotional stress, oxidative stress and isoprostane bio synthesis are also of some importance in the occurrence
Acquired von Willebrand syndrome (AVWS) is an acquired bleeding disorder with clinical and laboratory features similar to those of the inherited form of the disease. AVWS is reported in many disorders, most frequently in myeloproliferative neoplasms and in, among others, essential thrombocythemia (ET). Interestingly, ET is associated with both the thrombotic and haemorrhagic complications, which occur in 20 % and 5-30 % of patients, respectively. The present report concerns a 38-year-old man, suffering from ET, who presented with two episodes of post-arthroscopic joint bleeding after synovectomy required for the treatment of synovial hypertrophy and chronic left knee joint synovitis. We discuss the current diagnostic approaches, as well as the risk factors predisposing to bleeding and its management, in patients with essential thrombocythemia.
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