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J Thorac Cardiovasc Surg 2003;126:837-841
© 2003 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Platelet dysfunction in acute type A aortic dissection evaluated by the laser light-scattering method

^a Department of Cardiovascular Surgery, Omiya Medical Center, Jichi Medical School, Saitama, Japan

Received for publication March 5, 2003; revisions received March 25, 2003; revisions received April 6, 2003; accepted for publication April 15, 2003.

^* Address for reprints: Masashi Tanaka, MD, Department of Cardiovascular Surgery, Omiya Medical Center, Jichi Medical School, 1-847 Amanuma, Saitama 330-0834, Japan
masashi{at}omiya.jichi.ac.jp

OBJECTIVES: Platelet dysfunction contributes to bleeding tendency in acute type A aortic dissection. Particle counting by new laser light-scattering methods more accurately quantifies changes in the number of different-sized platelet aggregates than do conventional optical density methods. We studied platelet aggregation kinetics and patterns of aggregation deficiency in acute-phase aortic dissection with laser light scattering.

METHODS: Blood from 20 acute type A aortic dissection patients undergoing surgery was sampled during acute (9.1 ± 6.8 hours from onset) and chronic (postoperative day 20, control) phases of aortic dissection. Platelet count and aggregability were assessed by optical density and laser light-scattering methods after aggregation was induced (addition of 2.0 µg/mL collagen to samples).

RESULTS: Optical density showed significant reduction in acute-phase platelet aggregation (acute vs chronic: 65 ± 27% vs 77 ± 17%, P < .03). Laser light scattering showed significant reduction in medium (25-50 µm) and large (50-70 µm) but not small aggregate (9-25 µm) generation (acute vs chronic: small, 1.2 ± 0.6 x 10⁷ vs 1.5 ± 1.0 x 10⁷, NS; medium, 0.6 ± 0.3 x 10⁷ vs 1.1 ± 0.5 x 10⁷, P < .001; large, 1.4 ± 1.2 x 10⁷ vs 2.6 ± 1.7 x 10⁷, P < .001). Acute- versus chronic-phase platelet counts were significantly decreased (1.7 ± 0.1 x 10⁵/µL vs 3.6 ± 0.3 x 10⁵/µL, P < .001).

CONCLUSIONS: Platelet aggregation is suppressed in acute-phase aortic dissection. This suppression does not occur in the initial phase of small aggregate formation; rather, it occurs during the conglomeration of small aggregates into larger aggregates.

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