Diabetes and Other Comorbidities Could Greatly Hurt Platelet Function

When a medical condition is paired with another, it could make for a trickier situation. New research found that some diseases can significantly impact platelet function while others appear to have no effect.

The influence of comorbidities on platelet function has not been fully investigated, according to researchers from the Cleveland Clinic in Ohio. So the team set out to uncover how other conditions, such as types of heart failure, play a role in how healthy platelets stop bleeding. Their findings were presented in a poster session at the 57^th American Society of Hematology Annual Meeting (ASH 2015) in Orlando, Florida.

From August 2008 to August 2013, a total of 497 patients underwent platelet aggression using light transmission aggregometry (LTA). During this time, the patients’ comorbidities were recorded. They found the following conditions:

• Hypothyroidism: 71 patients
• Diabetes mellitus: 65 patients
• Vitamin D deficiency: 39 patients
• Systolic heart failure: 26 patients
• Diastolic heart failure: 25 patients
• Severe aortic stenosis: 17 patients

The Fisher’s exact test or Chi square test were used to evaluate categorical variables and the Mann-Whitney test looked at continuous measures. The Pearson co-efficient was used as well and scores were considered significant if P < 0.05.

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“Diastolic heart failure was found to be associated with impaired aggregation in the presence of ADP [adenosine diphosphate], collagen, or arachidonic acid and to > 2 agonists in the aggregation panel while systolic heart failure was not associated with any abnormality in aggregation or release,” the authors wrote. While diastolic heart failure proved to be associated with abnormalities in platelet aggregation, systolic heart failure was not.

Diabetes, on the other hand, was associated with impaired platelet aggregation but only in the presence of collagen. There was impaired platelet release observed in the presence of epinephrine. However, neither of these occurred in relation with glycated hemoglobin level (HbA1C).

Severe aortic stenosis did not correlate with impairments in platelet aggression, but it was associated with prolonged collagen/ADP and collagen/epinephrine closure times with PFA-100. The authors said that the Von Willebrand factor (VWF) test revealed the condition was linked to decreased ristocetin cofactor/VWF antigen ratio (0.66+0.17 vs. 0.90+0.37). Previous studies have suggested that stress from aortic stenosis could sway testing results.

Furthermore, hypothyroidism and vitamin D deficiency did not influence any of the levels during the study. Therefore, these findings highlight conditions that clinicians may want to keep their eyes on.

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