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Impact of Atrial Fibrillation and Sinus Rhythm Restoration on Reticulated Platelets

Published:October 30, 2015DOI:https://doi.org/10.1016/j.mayocp.2015.09.013

      Abstract

      Objective

      To assess the impact of nonvalvular atrial fibrillation (NVAF) and sinus rhythm restoration on the distribution of reticulated platelets (RPs), which are known to be associated with thrombotic propensity and have a greater predilection for thrombus participation.

      Participants and Methods

      The RP content was assessed by flow cytometry (thiazole orange/CD61) in 110 consecutive patients with NVAF before and 3 to 4 months after catheter ablation of the pulmonary veins. Results were compared with those of 55 age- and sex-matched controls with normal sinus rhythm.

      Results

      The mean ± SD percentage of RPs was higher in patients with NVAF compared with controls (28.5%±7.3% vs 6.4%±5.3%; P<.001). The RP content did not vary by CHA2DS2-VASc score. After catheter ablation of the pulmonary veins, 63 patients were available for follow-up assessment. A significant reduction of RPs was observed compared with preintervention values (29.85%±7.1% vs 20.79%±7.6%; P<.001). During follow-up, 19% of patients (12 of 63) had confirmed AF recurrence. The mean ± SD percentage of RPs was higher in this group than in those without a recurrence (24.7%±6.5% vs 18.9%±7.5%; P=.01).

      Conclusion

      Nonvalvular atrial fibrillation affects the percentage of RPs, independent of the CHA2DS2-VASc score. After ablation, RP content dropped significantly. High RP content in patients with NVAF may explain the potential mechanism of thromboembolic complications and the lack of efficacy of currently available antiplatelet therapy for stroke prevention in this dysrhythmia.

      Abbreviations and Acronyms:

      CHF (congestive heart failure), CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years (doubled), diabetes mellitus, stroke (doubled)–vascular disease, age 65 to 74 years, and sex category (female)), EKG (electrocardiography), H/H (HEPES-buffered (20 mM) Hanks balanced salt solution glucose (0.05%)), LVEF (left ventricular ejection fraction), NSR (normal sinus rhythm), NVAF (nonvalvular atrial fibrillation), PRP (platelet-rich protein), RP (reticulated platelet), SEC (spontaneous echocardiographic contrast), TEE (transesophageal echocardiography), TIA (transient ischemic attack), TO (thiazole orange), WB (whole blood)
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