Immature platelet fraction in cardiovascular diagnostics and antiplatelet therapy monitoring

Abstract

Immature platelet fraction (IPF), circulating platelets still containing RNA, can be easily calculated by automated flow cytometry, this makes them an accessible biomarker. Higher IPF concentrations were reported in patients with thrombocytopenia, patients who were smokers, and also those who were diabetics. Several studies have reported their diagnostic and prognostic importance in patients presenting with acute coronary syndromes, especially ST-segment elevation myocardial infarction, where increased IPF level is an independent predictor of cardiovascular death. In addition, higher IPF were reported in patients with inadequate response to either clopidogrel or prasugrel, suggesting their potential role in antiplatelet therapy monitoring. Their prognostic significance was also observed in both coronary artery disease and postcardiac surgery status, where their higher levels correlated with the risk of major adverse cardiac events. The current review aims to present the current evidence on diagnostic, prognostic and potentially therapeutic roles of IPF in cardiovascular medicine.

Keywords: acute coronary syndromes; antiplatelet therapy monitoring; immature platelet fraction.

Figure 1

Thrombopoietin concentration and immature platelet fraction values (adapted from: [24]).

Figure 2

Outcome events stratified by immature platelet fraction tertile (adapted from: [28]); MACE — major adverse cardiovascular events; NSTEMI — non-ST-segment elevation myocardial infarction.

Figure 3

Immature platelet fraction and ADP-induced platelet aggregation in ticagrelor and prasugrel treated patients (adapted from: [34]).

Central illustration

An outline of the most important information about immature platelet fraction (IPF); ACS — acute coronary syndrome; modMACE — major adverse cardiovascular events, deep vein thrombosis or pulmonary embolism during hospital stay; STEMI — ST-segment elevation myocardial infarction.