Platelet aggregation, mean platelet volume and plasma fibrinogen as risk factors for acute myocardial infarction

Geeta Yadav, Rashmi Kushwaha, Wahid Ali, Uma S. Singh, Ashutosh Kumar, Sharad Chandra, Ashish Awasthi, Prabhaker Mishra


Background: The Aim of this study was to assess the role of platelet aggregation, mean platelet volume (MPV) and plasma fibrinogen levels in the pathogenesis of acute myocardial infarction (AMI).

Methods: A prospective case control study was conducted on 30 cases of AMI and 30 normal healthy age and sex matched controls. The cases and controls were investigated for platelet aggregation studies (done in platelet rich plasma (PRP) using light transmission chrono-log optical aggregometer), MPV (measured by automated cell counter) and plasma fibrinogen levels (estimated by Clauss method).

Results: The mean platelet aggregation (%) in cases AMI was 57.61±11.91 which was significantly higher compared with 35.00±10.40 for healthy controls (p<0.001). Using Receiver Operating Characteristic (ROC) analysis, most patients of AMI had a platelet aggregability of ≥49% on optical aggregometry (sensitivity = 83.3 % and specificity = 93.7%). The MPV (fL) in cases of AMI was 8.04±0.39 which was significantly larger when compared with 7.67±0.43 for controls (p= 0.001). The mean plasma fibrinogen concentration in cases of AMI was 383.1±48.3mg/dl which was significantly higher when compared with 271.33±57.7mg/dl for healthy controls (p<0.001).

Conclusions: Platelet hyperaggregability, elevated MPV and plasma fibrinogen levels are found in patients with AMI and contribute significantly to risk of developing coronary thrombosis. These variables should be considered as additional screening tools to identify individuals at increased risk of developing AMI.


Acute myocardial infarction, Fibrinogen, Mean platelet volume, Platelet hyperaggregation

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Goel PK, Bharti BB, Pandey CM, Singh U, Tewari S, Kapoor A, et al. A tertiary care hospital-based study of conventional risk factors including lipid profile in proven coronary artery disease. Indian Heart J. 2003;55:234-40.

Falk E. Pathogenesis of atherosclerosis. J Am Coll Cardiol. 2005;47:7-12.

Faxon DP, Fuster V, Libby P, Beckman JA, Hiatt WR, Thompson RW, et al. Atherosclerotic vascular disease conference: writing group III: pathophysiology. Cir. 2004;109(21):2617-25.

Crowther MA. Pathogenesis of atherosclerosis. Hematology Am Soc Hematol Edu Program. 2005:436-41.

Kannel WB, Castelli WP, Gordon T, McNamara PM. Serum cholesterol, lipoproteins and risk of coronary heart disease: The Framingham study. Ann Intern Med. 197;74(1):1-12.

Yano K, Grove JS, Chen R, Rodriguez BL, Curb JD, Tracy RP. Plasma fibrinogen as a predictor of total and cause-specific mortality in elderly Japanese-American men. Arterio Throm Vas Biol. 2001;21:1065-70.

Yarnell JWG, Baker IA, Sweetnam PM, Bainton D, O’Brien JR, Whitehead PJ, et al. Fibrinogen, viscosity, and white blood cell count are major risk factors for ischemic heart disease. The Caerphilly and Speedwell collaborative heart disease studies. Circulation. 1991;83(3):836-44.

Massberg S, Schulz C ,Gawaz M. Role of platelets in the pathophysiology of acute coronary syndrome. Semin Vas Med. 2003;3:147-62.

Harrison P, Mackie I, Mathur A, Robinson MS, Hong Y, Erusalimsky JD, et al. Platelet hyper-function in acute coronary syndromes. Blood Coa Fibrinolysis. 2005;16(8):557-62.

Shin EK, Park H, Noh JY, Lim KM, Chung JH. Platelet shape changes and cytoskeleton dynamics as novel therapeutic targets for anti-thrombotic drugs. Biomole Therap. 2017;25(3):223-30.

Thompson CB, Eaton KA, Princiotta SM, Rushin CA, Valeri CR. Size dependent platelet subpopulations: relationship of platelet volume to ultrastructure, enzymatic activity, and function. Br J Haematol. 1982;50(3):509-19.

Khandekar MM, Khurana AS, Deshmukh SD, Kakrani AL, Katdare AD, Inamdar AK. Platelet volume indices in patients with coronary artery disease and acute myocardial infarction: an Indian scenario. J Clin Pathol. 2006;59(2):146-9.

Bath P, Algert C, Chapman N, Neal B, Progress Collaborative Group. Association of mean platelet volume with risk of stroke among 3134 individuals with history of cerebrovascular disease. Stroke. 2004;35(3):622-6.

Fullard JF. The role of the platelet glycoprotein IIb/IIIa in thrombosis and hemostasis. Curr Pharm Pes. 2004;10(14):1567-76.

Kul AN, Ozdemir S, Helvaci A, Bulut C, Dursun S. The relationship of acute myocardial infarction with or without ST-segment elevation and viscosity. Clin App Thromb Hemost. 2014;20(8):779-82.

Wu MD, Atkinson TM, Lindner JR. Platelets and von Willebrand factor in atherogenesis. Blood. 2017;129(11):1415-19.

Li Z, Delaney MK, O’Brien KA, Du X. Signaling during platelet adhesion and activation. Arteriosclerosis, thrombosis, and vascular biology. 2010;30(12):2341-49.

Gawaz M. Role of platelets in coronary thrombosis and reperfusion of ischemic myocardium. Cardiovasc Res. 2004;61:498-511.

Fuchs J, Weinberger I, Rotenberg Z, Joshua H, Almozlino A, Agmon J. Circulating platelets in coronary artery disease. Am J Cardiol. 1987;60(7):534-7.

Ikeda Y, Handa M, Kawano K, Kamata T, Murata M, Araki Y, et al. The role of von Willebrand factor and fibrinogen in platelet aggregation under varying shear stress. J Clin Invest. 1991;87(4):1234-40.

Eto K, Ochiai M, Isshiki T, Takeshita S, Terakura M, Sato T, et al. Platelet aggregability under shear is enhanced in patients with unstable angina pectoris who developed acute myocardial infarction. Jpn Cir J. 2001;65(4):279-82.

Guha S, Mookerjee S, Lahiri P, Mani S, Saha J, Guha S, et al. A study of platelet aggregation in patients with acute myocardial infarction at presentation and after 48 hrs of initiating standard anti platelet therapy. Ind Heart J. 2011;63(5):409-13.

Endler G, Klimesch A, Sunder-Plassmann H, Schillinger M, Exner M, Mannhalter C, et al. Mean platelet volume is an independent risk factor for myocardial infarction but not for coronary artery disease. Br J Haematol. 2002;117(2):399-404.

Ranjith MP, Divyaraj R, Mathew D, George B, Krishnan MN. Mean platelet volume and cardiovascular outcomes in acute myocardial infarction. Heart Asia. 2016;8(1):16-20.

Papageorgiou N, Tousoulis D, Siasos G, Stefanadis C. Is fibrinogen a marker of inflammation in coronary artery disease? Hellenic J Cardiol. 2010;51:1-9.

Ahmed MS, Jadhav AB, Hassan A, Meng QH. Acute phase reactants as novel predictors of cardiovascular disease. ISRN Inflamm. 2012;2012:953461.