© Schattauer 2015 Thrombosis and Haemostasis 114.6/2015 1299 Prognostic effect of mean platelet volume in patients with coronary artery disease A systematic review and meta-analysis Nakarin Sansanayudh 1,2 ; Pawin Numthavaj 1 ; Dittapol Muntham 1 ; Sukit Yamwong 3 ; Mark McEvoy 4 ; John Attia 4 ; Piyamitr Sritara 3 ; Ammarin Thakkinstian 1 1 Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2 Cardiology Unit, Department of Internal Medicine, Phramongkutklao Hospital, Bangkok, Thailand; 3 Division of Cardiology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand; 4 Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, New South Wales, Australia Summary Large platelets with high haemostatic activity may lead to increased platelet aggregation.. Mean platelet volume (MPV), an indicator of platelet reactivity, may emerge as a prognostic marker in patients with coronary artery disease (CAD). It was the objective of this study to conduct a systematic review and meta-analysis to assess prognostic effects of MPV on cardiovascular events (CVE) in CAD patients. We searched MEDLINE and SCOPUS from inception to January 2, 2014. All studies that reported MPV and the incidence of cardiovascular events in CAD patients were included. Two reviewers independently extracted the data. A random-effects model was applied for pooling the mean difference of MPV between patients with vs without CVE. Among 30 eligible studies, eight studies reported mean difference of MPV between CVE groups, 11 studies reported MPV dichotomous into high vs low MPV groups, and 11 studies reported both. The pooled mean difference was 0.69 fL (95 %CI = 0.36, 1.01), i. e. patients with CVE had a MPV about 0.69 fL higher than non-CVE. Patients with higher MPV were about 12 % more likely to die than patients with lower MPV (RR 1.12; 95 %CI = 1.02–1.24). However, pooling these ef- fects was based on high heterogeneity and the source of heteroge- neity could not be identified. This might be explained by many differ- ences among included studies (e. g. study population, outcomes of in- terest, analysate, time between blood collection and MPV analysis, etc). These findings suggest that MPV may be a useful prognostic marker in patients with CAD. Keywords Mean platelet volume, coronary artery disease, cardiovascular diseases, prognosis, meta-analysis Correspondence to: Pawin Numthavaj, MD Section for Clinical Epidemiology and Biostatistics Faculty of Medicine, Ramathibodi Hospital, Mahidol University 370 Rama VI road, Rajathevi, 10400 Bangkok, Thailand Tel.: 6622011284, Fax: 6622011284 E-mail: pawin.num@mahidol.ac.th Received: April 5, 2015 Accepted after major revision: June 17, 2015 Epub ahead of print: August 6, 2015 http://dx.doi.org/10.1160/TH15-04-0280 Thromb Haemost 2015; 114: 1299–1309 Atherosclerosis and Ischaemic Disease Introduction Patients with coronary artery disease (CAD) have increased risk of death, myocardial infarction (MI) and other cardiovascular events (CVE). Many factors (e. g. age, vital status, underlying disease, etc) have been used to predict CVEs in various subgroups of CAD pa- tients. These factors have been included in some prediction scores (GRACE [1, 2], TIMI [3], PURSUIT [4], etc.) that are widely used in clinical practice for predicting risk of future events in CAD patients. However, these known prognostic factors only partially explain the risk and the current prediction scores still have some limitations (5). Therefore, there is still a need for new markers that are easy to measure and available in routine practice, which can be used to pre- dict progression of CVE and improve the prediction score in order to achieve better stratification of disease progression. Platelets play a pivotal role in the pathophysiology of cardiovas- cular events in all types of CAD patients (6). Platelet activation is a fundamental step in triggering acute coronary syndrome (ACS) which leads to mortality in many CAD patients. Antiplatelet agents have been shown to reduce CVE in CAD patients and are recommended by every guideline as secondary prevention in pa- tients with CAD (7–9). High residual platelet activity in patients taking antiplatelet agents have also been shown to be a predictor of increased risk of CVE (10, 11). However, platelet function tests are time consuming, expensive, technically difficult and not widely available; therefore limiting its use in clinical practice. Mean platelet volume (MPV) is a measurement of platelet size. Larger platelets contain more dense alpha granules, express more adhesive receptors, and have higher thrombotic activity (12, 13). Although measurement of MPV is inexpensive, simple, easy to in- terpret, and already widely available from the complete blood count (CBC); it has received little attention until the last five years. In addition, there have been a number of studies that have as- sessed the effects of MPV on CAD progression. Many studies re- ported that MPV is a valuable prognostic factor in CAD patients (14–16); however, some studies were unable to replicate these For personal or educational use only. No other uses without permission. All rights reserved. Downloaded from www.thrombosis-online.com on 2017-01-06 | ID: 1001043553 | IP: 202.28.179.5