Platelet adhesiveness in patients with prosthetic heart valves
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Thromboembolism continues to be a major complication occurring after prosthetic heart valve replacement. It is thought that thrombus formation on prosthetic surfaces may be primarily related to the adherence of platelets with subsequent platelet aggregates and the deposition of fibrin.Platelet adhesiveness was examined in 40 patients with Björk-Shiley prosthetic heart valves; 28 of them were receiving 1500-2250mg of clofibrate, 5 receiving 300mg of dipyridamole, and the remaining 7 receiving warfarin alone. None of the patients had a history of thromboembolism. Platelet adhesiveness in a glass bead column was determined by a modified technique of Salzman. It is known that by this method not only platelet adhesiveness was detected but also platelet aggregation induced by ADP which was released from erythrocytes hemolysing on the glass surface owing to the blood flow. Student's t-test was used to compare the means for statistical significance.The mean platelet adhesiveness in patients with prostheses was decreased, and differed significantly (p<0.005) from the normal control value. It seemed likely that a platelet suppressant drug such as clofibrate or dipyridamole play a role in decreased adhesiveness. The mean platelet adhesiveness in 13 patients with an aortic prosthesis receiving clofibrate alone was not statistically different from that in 9 patients with a mitral prosthesis receiving clofibrate in combination with warfarin. Four of 7 patients receiving warfarin alone showed a relatively decreased platelet adhesiveness of below 15%, but there was no obvious correlation between platelet adhesiveness and Thrombotest value in these patients.The mean platelet count in patients with double prostheses was relatively low, and differed significantly from that in patients with an aortic or with a mitral prosthesis (p<0.0005 and p<0.01 respectively). The mean platelet adhesiveness in patients with an aortic prothesis was slightly decreased, and differed significantly (p<0.05) from that in patients with a mitral prothesis. The mean platelet count in patients with atrial fibrillation was signficantly (p<0.0005) different from the count in those with normal sinus rhythm, but no significant difference was found in platelet adhesiveness between the two groups.No correlation was found between platelet count and adhesiveness, and also between hematocrit (ranging 24 to 47%) and platelet adhesiveness in the patients with prostheses.The measurement of platelet adhesiveness by this method is easy to do and thought to be useful. However, further studies are expected on correlations between the platelet adhesivness and other platelet functions including platelet aggregation, platelet survival time and also the clinical incidence of thromboembolism.
- 一般社団法人 日本血栓止血学会の論文
一般社団法人 日本血栓止血学会 | 論文
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