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. 2014 Nov;134(5):952-6.
doi: 10.1016/j.thromres.2014.08.009. Epub 2014 Aug 23.

Platelet activation increases in patients undergoing vascular surgery

Gabriel S Schneider  1 , Caron B Rockman  2 , Jeffrey S Berger  3
Affiliations

Platelet activation increases in patients undergoing vascular surgery

Gabriel S Schneider et al. Thromb Res. 2014 Nov.

Abstract

Background: Platelets are a major contributor to atherothrombosis and may contribute to the heightened risk of perioperative cardiovascular events. We sought to examine changes in platelet activity in subjects undergoing vascular surgery.

Methods: Platelet activity in 18 patients (median age 74, 45% female) undergoing non-emergent open vascular surgery was assessed by light transmission aggregometry in response to saline, epinephrine and adenosine-5 diphosphate (ADP), and by flow cytometric analysis of monocyte-platelet aggregation (MPA). Platelet activity was assessed preoperatively (T1), 1-hour into the operation (T2), 1-hour (T3), 24-hours (T4) and 48-hours post-operatively (T5). Data were compared using the Wilcoxon Signed Ranks Test. Continuous variables are summarized as medians and (interquartile, IQR) ranges.

Results: Spontaneous platelet aggregation increased transiently during the surgical period (T1-5.8% [2.4, 10.8], T2-13.5% [9.3, 26.5], T3-7.5% [3.3, 17], T4-10.0% [7.3, 16.3], T5-7.25% [4.5, 29.9], P=0.002). Similar trends in perioperative platelet activity were noted for platelet aggregation in response to epinephrine (P=0.035) and ADP (P=0.036). Using flow cytometry, we found an increase in MPA during the perioperative period (P=0.047), which was most significant between T1 and T3 (P=0.005).

Conclusions: Platelet activity increases significantly during and following open vascular surgery. This data may help explain the pathophysiology of increased thrombotic risk during the perioperative period of vascular surgery.

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Figures

Figure 1
Figure 1
Hematology analysis of the a) white blood cell count, b) hematocrit and c) platelet count during the perioperative period. White blood cell count gradually increased with each sample, hematocrit decreased over time, and platelet count was not significantly different over time, with the only significant difference occurring between T1 and T3.
Figure 2
Figure 2
Platelet aggregation in response to a) saline (spontaneous platelet aggregation), b) epinephrine, c) ADP and d) arachidonic acid during the perioperative period. Spontaneous platelet aggregation increased transiently during the surgical period. A similar transient increase was also seen in platelet aggregation in response to epinephrine, ADP and arachidonic acid.
Figure 3
Figure 3
Monocyte platelet aggregation, PAC-1 expression and PAC-1 expression in response to epinephrine during the perioperative period. Monocyte platelet aggregation showed a transient increase during the perioperative period, peaking at T3. Similarly, PAC-1 expression and PAC-1 expression in response to epinephrine 0.4μM both demonstrated a significant increase perioperatively, with their peaks occurring at T2.
See this image and copyright information in PMC

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