The platelet release reaction in cardiovascular disease: evaluation of plasma betathromboglobulin as a marker of a prothrombotic state

Plasma betathromboglobulin as a marker of in vivo platelet release was found to be significantly higher in 131 patients with prosthetic cardiac valves and 104 patients with coronary artery disease, compared with 133 normal individuals. Patients with double mechanical valves had a higher mean betathromboglobulin than those with single mechanical valves, who in turn had higher values than those with single heterograft valves. Thirteen patients adequately anticoagulated at the time of a thromboembolic event had significantly higher betathromboglobulin levels than 5 with thromboemboli when not anticoagulated, suggesting platelets were responsible for the emboli in the former group. The presence of coronary risk factors in normal individuals did not affect betathromboglobulin; however, when two or more risk factors were present in patients with ischaemic heart disease, mean betathromboglobulin was higher than when only one or no risk factors were present. This suggests greater platelet activation in the presence of more widespread atherosclerotic disease. Thus mean plasma betathromboglobulin is higher in groups of patients with disorders known to have thrombotic complications, but the wide range of values, which overlap with normals, prevent the clinical interpretation of the plasma betathromboglobulin level found in any individual patient.