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Platelet reactivity and mean platelet volume as new biomarkers in risk stratification in patient with atrial fibrillation
International Journal of Cardiology 244 (2017) 297
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Platelet reactivity and mean platelet volume as new biomarkers in risk stratification in patient with atrial fibrillation Marcin Makowski a,⁎, Zbigniew Baj b a b
Department of Interventional Cardiology and Cardiac Arrhythmias, Medical University of Lodz, Poland Department of Pathophysiology and Immunology, Medical University of Lodz, Poland
a r t i c l e
i n f o
Article history: Received 3 May 2017 Accepted 8 May 2017
Dear Shu Wang and Jing Li, Thank you for very valuable comments to our study. We completely agree that there is still lack of methods of precise estimation of thromboembolic complications (TE) risk, especially in the group of CHA2DS2-VASc score 1. It is striking that these patients according to studies on Asian population have higher risk over 2% as compared to European studies [1,2]. According to our studies [3,4] even patients with lone atrial fibrillation have increased platelet reactivity which reflects procoagulable state. Thus we agree with Authors that we should search for more precise, reliable, easy and useful scores which include laboratory test to minimalize thromboembolic complications. Platelet activation and reactivity measured by flow cytometry could be additional marker, but in our opinion, in everyday clinical practice may be problematic due to several issues: short time to examination (optimal
DOI of original article: http://dx.doi.org/10.1016/j.ijcard.2017.04.012. ⁎ Corresponding author. E-mail address: [email protected] (M. Makowski).
http://dx.doi.org/10.1016/j.ijcard.2017.05.033 0167-5273/© 2017 Elsevier B.V. All rights reserved.
within 1 h), high cost of the procedure and lack of availability of flow cytometry in every laboratory. However there are a lot of proposed biomarkers which have confirmed impact on prediction of TE complications (MPV, fibrinogen, D-dimer, troponin, NT pro BNP), which are easier to examine. However it can be discussed if two biomarkers which are proposed by current guidelines: troponin and NT pro BNP [5] do not reflect the nondiagnosed heart disease increasing the risk of TE. Nevertheless, the large studies on proposed combined indexes assessing the risk of thromboembolic complications should be performed to validate its usefulness. References [1] T.F. Chao, Should atrial fibrillation patients with 1 additional risk factor of the CHA2DS2-VASc score (beyond sex) receive oral anticoagulation? J. Am. Coll. Cardiol. 65 (7) (2015) 635–642. [2] C.W. Siu, L.G., K.-F. Lam, et al., Risk of stroke and intracranial hemorrhage in 9727 Chinese with atrial fibrillation in Hong Kong, Heart Rhythm. 11 (2014) (2014) 1401–1408. [3] M. Makowski, et al., Effect of sinus rhythm restoration on platelet function in patients with lone atrial fibrillation, Int. J. Cardiol. 172 (1) (2014) e22–e23. [4] M. Makowski, et al., Platelet reactivity and mean platelet volume as risk markers of thrombogenesis in atrial fibrillation, Int. J. Cardiol. 235 (2017) 1–5. [5] P. Kirchhof, et al., ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS, Eur. Heart J. 37 (38) (2016) 2893–2962.
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Platelet reactivity and mean platelet volume as new biomarkers in risk stratification in patient with atrial fibrillation Marcin Makowski a,⁎, Zbigniew Baj b a b
Department of Interventional Cardiology and Cardiac Arrhythmias, Medical University of Lodz, Poland Department of Pathophysiology and Immunology, Medical University of Lodz, Poland
a r t i c l e
i n f o
Article history: Received 3 May 2017 Accepted 8 May 2017
Dear Shu Wang and Jing Li, Thank you for very valuable comments to our study. We completely agree that there is still lack of methods of precise estimation of thromboembolic complications (TE) risk, especially in the group of CHA2DS2-VASc score 1. It is striking that these patients according to studies on Asian population have higher risk over 2% as compared to European studies [1,2]. According to our studies [3,4] even patients with lone atrial fibrillation have increased platelet reactivity which reflects procoagulable state. Thus we agree with Authors that we should search for more precise, reliable, easy and useful scores which include laboratory test to minimalize thromboembolic complications. Platelet activation and reactivity measured by flow cytometry could be additional marker, but in our opinion, in everyday clinical practice may be problematic due to several issues: short time to examination (optimal
DOI of original article: http://dx.doi.org/10.1016/j.ijcard.2017.04.012. ⁎ Corresponding author. E-mail address: [email protected] (M. Makowski).
http://dx.doi.org/10.1016/j.ijcard.2017.05.033 0167-5273/© 2017 Elsevier B.V. All rights reserved.
within 1 h), high cost of the procedure and lack of availability of flow cytometry in every laboratory. However there are a lot of proposed biomarkers which have confirmed impact on prediction of TE complications (MPV, fibrinogen, D-dimer, troponin, NT pro BNP), which are easier to examine. However it can be discussed if two biomarkers which are proposed by current guidelines: troponin and NT pro BNP [5] do not reflect the nondiagnosed heart disease increasing the risk of TE. Nevertheless, the large studies on proposed combined indexes assessing the risk of thromboembolic complications should be performed to validate its usefulness. References [1] T.F. Chao, Should atrial fibrillation patients with 1 additional risk factor of the CHA2DS2-VASc score (beyond sex) receive oral anticoagulation? J. Am. Coll. Cardiol. 65 (7) (2015) 635–642. [2] C.W. Siu, L.G., K.-F. Lam, et al., Risk of stroke and intracranial hemorrhage in 9727 Chinese with atrial fibrillation in Hong Kong, Heart Rhythm. 11 (2014) (2014) 1401–1408. [3] M. Makowski, et al., Effect of sinus rhythm restoration on platelet function in patients with lone atrial fibrillation, Int. J. Cardiol. 172 (1) (2014) e22–e23. [4] M. Makowski, et al., Platelet reactivity and mean platelet volume as risk markers of thrombogenesis in atrial fibrillation, Int. J. Cardiol. 235 (2017) 1–5. [5] P. Kirchhof, et al., ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS, Eur. Heart J. 37 (38) (2016) 2893–2962.