The Relationship Between Platelet Activation and Recanalization Time in Cerebral Venous Thrombosis

Öz

Objective: Cerebral venous thrombosis is a rare cause of stroke. Treatment consists of anticoagulant agents. Aim of treatment is to remove the clot and maintain the recanalization. Duration of recanalization often lasts between 3 and 12 months. Thrombocytes have an important role in thrombosis. Mean thrombocyte volume (MTV) and thrombocyte distribution width (TDW) are the parameters associated with thrombocyte activation. In this study, we investigated the possible factors that affect the recanalization duration and assessed link between recanalization and the MTV and TDW.

Material and Method: Between January 2012 and June 2018 Our retrospective study includes 37 patients (6 male, 31 female) who had the diagnosis of cerebral venous thrombosis followed by recanalization. Control group consisted of age and gender matched healthy individuals.

Results: MTV and TDW were higher in thrombosis group. Mean recanalization duration was 7.7 months. Age, gender, etiology, presence of parenchymal injury, and number of affected sinus were not associated with recanalization duration. Superior sagittal sinus involvement was, statistically, found to be associated with recanalization duration.

Conclusions: Most of our findings differed from the literature. This suggests the methodological differences of our study. We also think that diverse results could be due to affected recanalization process by many factors at the same time and individual differences. We found that MTV and TDW cannot be used as biomarkers in the prediction of duration of recanalization.

Anahtar Kelimeler

• Mean thrombocyte volume,Thrombocyte distribution width,Cerebral venous thrombosis,Recanalization duration

Serebral Venöz Trombozda Trombosit Aktivasyonu ile Rekanalizasyon Süresi İlişkisi

Öz

Amaç: Serebral venöz tromboz nadir görülen bir inme nedenidir. Tedavide antikoagülan ajanlar kullanılmaktadır. Tedavide amaç trombozu ortadan kaldırarak rekanalizasyonu sağlamaktır. Rekanalizasyon süresi sıklıkla 3-12 ay arasında değişmektedir. Trombositlerin tromboz oluşumunda önemli rolü vardır. Ortalama trombosit hacmi (OTH) ve trombosit dağılım genişliği (TDG) trombosit aktivasyonunu gösteren parametrelerdir. Biz çalışmamızda rekanalizasyon süresi üzerine etki eden faktörleri, OTH ve TDG ile rekanalizasyon süresi arasında bir ilişki olup olmadığını belirlemeyi amaçladık.

Gereç ve Yöntemler: Çalışmamız retrospektif olup serebral venöz tromboz tanısı ile takipli ve takipte rekanalizasyon izlenen 37 hastayı kapsamaktadır.

Bulgular: Çalışmaya Ocak 2012-Haziran 2018 tarihleri arasında serebral venöz tromboz tanısı ile takip edilip rekanalizasyon izlenen 6’sı erkek, 31’i kadın 37 hasta ve yaş, cinsiyet eşleşmeli sağlıklı bireyler alındı. OTH ve TDG değerleri SVT grubunda anlamlı olarak daha yüksekti, ortalama rekanalizasyon süresi 7.7 aydı. Yaş, cinsiyet, etyoloji, parankim hasarı, tutulan sinüs ve tutulan sinüs sayısı rekanalizasyon süresi üzerine etkili değildi. Süperior sagital sinüs tutulumu ile rekanalizasyon süresi arasında anlamlı istatistiksel ilişki tespit edildi.

Sonuç: Tespitlerimizin çoğu literatür ile farklıydı,  bu durum metodolojik farklılıktan kaynaklanabileceği gibi rekanalizasyonun birçok faktör tarafından aynı anda etkilenebileceğini ve olguya göre değişebileceğini akla getirmektedir. Ayrıca OTH ve TDG’ nin rekanalizasyon süresinin tahmininde biyobelirteç olarak kullanımı uygun değildir.

Anahtar Kelimeler

• Ortalama trombosit hacmi,Trombosit dağılım genişliği,Serebral venöz tromboz,Reanalizasyon zamanı

Kaynakça

1. 1. Coutinho JM, Zuurbier SM, Aramideh M, Stam J. The incidence of cerebral venous thrombosis: a cross-sectional study. Stroke 2012;43:3375-3377.
2. 2. deVeber G, Andrew M, Adams C, Bjornson B, Booth F, Buckley DJ, Camfield CS, David M, Humphreys P, Langevin P, MacDonald EA, Gillett J, Meaney B, Shevell M, Sinclair DB, Yager J; Canadian Pediatric Ischemic Stroke Study Group. Cerebral sinovenous thrombosis in children. N Engl J Med 2001;345:417-423.
3. 3. Sparaco M., Feleppa M., Bigal M. E. Cerebral venous thrombosis and headache–a case-series. Headache 2015;55:806–814.
4. 4. Sassi S. B.,Touati N., Baccouche H., Drissi C., Romdhane N. B., Hentati F. Cerebral venous thrombosis: a tunisian monocenter study on 160 patients. Clin. Appl. Thromb. Hemost. 2016; 23:1005–1009.
5. 5. Agostoni E. Headache in cerebral venous thrombosis. Neurol. Sci. 2004;25:206–10. 6. Bousser MG. Cerebral venous thrombosis: diagnosis and management. J Neurol 2000;247: 252–8.
6. 7. Lettau M, Laible M, Barrows RJ, Heiland S, Bendszus M, Hahnel S. 3‐T contrast‐enhanced MR angiography with parallel imaging in cerebral venous and sinus thrombosis. J Neuroradiol 2011;38:275–2.
7. 8. Herweh C, Griebe M, Geisbüsch C, Szabo K, Neumaier-Probst E, Hennerici MG, Bendszus M, Ringleb PA, Nagel S. Frequency and temporal profile of recanalization after cerebral vein and sinus thrombosis. Eur J Neurol. 2016;23:681-7.
8. 9. Einhaupl K, Stam J, Bousser MG, De Bruijn SF, Ferro JM, Martinelli I, Masuhr F; European Federation of Neurological S . EFNS guideline on the treatment of cerebral venous and sinus thrombosis in adult patients. Eur J Neurol. 2010;17:1229–35.

9. 10. Saposnik G, Barinagarrementeria F, Brown RD Jr, Bushnell CD, Cucchiara B, Cushman M, deVeber G, Ferro JM, Tsai FY. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:1158–92.
10. 11. Arauz A, Vargas-González JC, Arguelles-Morales N, Barboza MA, Calleja J, Martínez-Jurado E, Ruiz-Franco A, Quiroz-Compean A, Merino JG. Time to recanalisation in patients with cerebral venous thrombosis under anticoagulation therapy. J Neurol Neurosurg Psychiatry. 2016;87:247-51.
11. 12. Putaala J, Hiltunen S, Salonen O, Kaste M, Tatlisumak T. Recanalization and its correlation to outcome after cerebral venous thrombosis. J Neurol Sci. 2010 ;292:11-15.13. M. Strupp, M. Covi, K. Seelos, M. Dichgans, T. Brandt. Cerebral venous thrombosis: correlation between recanalization and clinical outcome—a long-term follow-up of 40 patients. 2002;249:1123-4.
12. 14. D.W. Schultz, S.M. Davis, B.M. Tress, C.J. Kilpatrick, J.O. King. Recanalisation and outcome cerebral venous thrombosis. J Clin Neurosci. 1996;3:133-8.
13. 15. Baumgartner RW, Studer A, Arnold M, Georgiadis D. Recanalisation of cerebral venous thrombosis. J Neurol Neurosurg Psychiatry. 2003;74:459-61.
14. 16. Dentali F, Gianni M, Crowther MA, Ageno W. Natural history of cerebral vein thrombosis: a systematic review. Blood. 2006;108:1129-34.
15. 17. Güldiken B, Özkan H, Kabayel L. Mean Platelet Volume and Peripheral Blood Count Response in Acute Ischemic Stroke. Balkan Med J 2008;2:130-5.
16. 18. Nena E, Papanas N, Steiropoulos P, Zikidou P, Zarogoulidis P, Pita E, Constantinidis TC, Maltezos E, Mikhailidis DP, Bouros D. Mean Platelet Volume and Platelet Distribution Width in non-diabetic subjects with obstructive sleep apnoea syndrome: new indices of severity? Platelets 2012;23:447-54.
17. 19. Greisenegger S, Endler G, Hsieh K, Tentschert S, Mannhalter C, Lalouschek W. Is elevated mean platelet volume as sociated with a worse outcome in patients with acute ischemic cerebrovascular events? Stroke 2004;35:1688–1691.
18. 20. Chu SG, Becker RC, Berger PB, Bhatt DL, Eikelboom JW, Konkle B, Mohler ER, Reilly MP, Berger JS. Mean platelet volume as a predictor of cardiovascular risk: A systematic review and metaanalysis. J Thromb Haemost. 2010;8:148–56.
19. 21. Kamisli O, Kamisli S, Kablan Y, et al. The Prognostic Value of an Increased Mean Platelet Volume and Platelet Distribution Width in the Early Phase of Cerebral Venous Sinus Thrombosis. Clinical and Applied Thrombosis/Hemostasis 2013;19:29-32.
20. 22. Braekkan SK, Mathiesen EB, Njølstad I, Wilsgaard T, Størmer J, Hansen JB. Mean platelet volume is a risk factor for venous thromboembolism: The TromsøStudy, Tromsø, Norway. J Thromb Haemost. 2010;8:157–62.
21. 23. Kostrubiec M, Łabyk A, Pedowska-Włoszek J, HrynkiewiczSzymańska A, Pacho S, Jankowski K, Lichodziejewska B, Pruszczyk P. Mean platelet volume predicts early death in acute pulmonary embolism. Heart 2010;96:460–5.
22. 24. Qiu Z, Sang H, Dai Q, Xu G. Endovascular treatments for cerebral venous sinus thrombosis. J Thromb Thrombolysis 2015;40:353–62.
23. 25. Karadas S, Milanlioglu A, Gönüllü H, Sayin R, Aydin M. N. Cerebral venous sinus thrombosis presentation in emergency department in Van, Turkey. J. Pak. Med. Assoc. 2014;64:370–4.
24. 26. Bousser M-G, Ferro JM. Cerebral venous thrombosis: an update. Lancet Neurol 2007;6:162–70.
25. 27. Gunes H. N, Cokal B. G, Guler S. K, Yoldas T. K, Malkan U. Y, Demircan C. S, et al. Clinical associations, biological risk factors and outcomes of cerebral venous sinus thrombosis. J. Int. Med. Res. 2016;44:1454–61.
26. 28. Bousser MG, Crassard I. Cerebral venous thrombosis, pregnancy and oral contraceptives. Thromb Res 2012;130:19–22.
27. 29. Masuhr F, Mehraein S, Einhaupl K. Cerebral venous and sinus thrombosis. J Neurol. 2004; 251:11-23. 30. Stolz E, Trittmacher S, Rahimi A, Gerriets T, Röttger C, Siekmann R, Kaps M. Influence of recanalization on outcome in dural sinus thrombosis: a prospective study. Stroke. 2004;35:544-7.
28. 31. Gazioglu S, Eyuboglu I, Yildirim A, Aydin CO, Alioglu Z. Cerebral venous sinus Thrombosis: Clinical Features, Long-Term outcome and recanalization. J Clin Neurosci. 2017;45:248-51.
29. 32. Ferro JM, Canhão P, Stam J, Bousser MG, Barinagarrementeria F; ISCVT Investigators. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke. 2004 Mar;35(3):664-70.
30. 33. Krajíčková D, Klzo L, Krajina A, Vyšata O, Herzig R, Vališ M. Cerebral Venous Sinus Thrombosis: Clinical Characteristics and Factors Influencing Clinical Outcome. Clin Appl Thromb Hemost. 2016 Oct;22(7):665-72.
31. 34. Lo´pez JA, Chen J. Pathophysiology of venous thrombosis. Thromb Res 2009;123:30-4.
32. 35. Kalkan A, Memetoğlu ME, Bilir Ö, Ersunan G, Kutlu R, Tutar N. Is Increased Mean Platelet Volume a Risk Factor in Patients with Acute Deep Vein Thrombosis? Tr J Emerg Med 2012;12:82-86.
33. 36. Mathur A, Robinson MS, Cotton J, Martin JF, Erusalimsky JD. Platelet reactivity in acute coronary syndromes: evidence for differences in platelet behaviour between unstable angina and myocardial infarction. Thromb Haemost 2001;85:989-94.
34. 37. Demirtunc R, Duman D, Basar M, Bilgi M, Teomete M, Garip T. The relationship between glycemic control and platelet activity in type 2 diabetes mellitus. J Diabetes Complications 2009;23:89-94.
35. 38. Bolayır A, Gökçe ŞF. The role of mean platelet volume, platelet distribution width and platelet/lymphocyte ratio in development of cerebral venous thrombosis. Cumhuriyet Medical Journal 2017; 39: 683-91.