Increased leukocyte-platelet adhesion in patients with graft occlusion after peripheral vascular surgery

Claire J. Esposito; Wanda M. Popescu; Henry M. Rinder; Jeffrey J. Schwartz; Brian R. Smith; Christine S. Rinder

doi:10.1160/TH03-04-0226

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2003; 90(06): 1128-1134
DOI: 10.1160/TH03-04-0226

Platelets and Blood Cells

Schattauer GmbH

Increased leukocyte-platelet adhesion in patients with graft occlusion after peripheral vascular surgery

Claire J. Esposito

¹Departments of Anesthesiology & Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA

,

Wanda M. Popescu

¹Departments of Anesthesiology & Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA

,

Henry M. Rinder

¹Departments of Anesthesiology & Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA

,

Jeffrey J. Schwartz

¹Departments of Anesthesiology & Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA

,

Brian R. Smith

¹Departments of Anesthesiology & Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA

,

Christine S. Rinder

¹Departments of Anesthesiology & Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA

› Author Affiliations

Abstract

Summary

Graft occlusion following peripheral vascular surgery is attributable to some combination of acute thrombosis, and progression of atherosclerosis: interactions between leukocytes and activated platelets may play a role in both of these processes. This investigation measured perioperative leukocyte-platelet conjugate formation, and leukocyte and platelet activation in 46 patients undergoing surgery for lower extremity peripheral vascular disease (PVD). All patients were followed for graft patency over the next 6 months; 27 patients had grafts that remained patent while 19 had graft occlusion. On postoperative day #1 (POD#1), the graft occlusion group demonstrated a significantly greater increase in circulating levels of both mono-cyteplatelet and neutrophil (PMN)-platelet conjugates compared to the patent graft patients (p=0.015 and 0.018, respectively). PMN activation, assessed by increases in surface CD11b expression, was also significantly increased on POD#1 in the graft occlusion group compared to the patent group (p=0.026). The percentage of circulating activated (CD62P+) platelets did not differ between groups, but patients with graft occlusion demonstrated a higher percentage of younger, reticulated platelets throughout the study period (p=0.008), indicating increased platelet turnover.

We conclude that in the early postoperative period, leukocyte-platelet adhesion, PMN activation, and platelet turnover are significantly greater in PVD patients who go on to develop later graft occlusion. Cellular activation and heterotypic cell interactions in peripheral vascular surgery patients may be important in the etiologies of thrombosis and/or accelerated atherosclerosis leading to graft loss.

Keywords

Cell-cell interactions - clinical/epidemiological studies - platelet activation markers - vasculopathies

Full Text

References

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