Other inflammatory markers should be kept in mind when assessing the mean platelet volume

We read with a great interest the article ‘‘Increased mean platelet volume (MPV) and mean platelet volume/platelet count (MPV/P) ratio in Korean patients with deep vein thrombosis (DVT)’’ written by Han and coworkers [1]. They aimed to compare the MPV and MPV/P ratio between DVT and control subjects. They demonstrated that MPV was higher in DVT patients compared to controls. The DVT patients also had a higher MPV/P ratio compared to the control group. MPV was conversely correlated with the platelet count in DVT patients. They suggested that the MPV and MPV/P ratio may be considered meaningful laboratory markers for the risk of DVT. The study is successful in design and documentation. DVT is a common disease found worldwide. It presents symptoms ranging from asymptomatic to fatal pulmonary embolism. So, prevention and early diagnosis of DVT are very important. The presence of DVT was closely associated with increased platelet activation [2]. Blood stasis, vascular endothelial injury, and hypercoagulable conditions are well-known risk factors of DVT. It has also been related to obesity, smoking, previous surgical history, trauma, cancer, immobilization and another platelet dysfunctions [3]. In contrast to the present study, the authors demonstrated downregulation of platelet activation after long-term immobilization in the previous study [4]. For this reason, we think that because platelet function can affect various factors, further studies should consider these conditions. A complete blood count is a routine, easy, and cheap examination technique that gives information about the patient’s formed blood contents; the red and white cells, platelets, the counts and dimensions of subgroups of cells, and parameters like the distribution widths, mean platelet volume. MPV is one of the most widely used laboratory markers to be related to the platelet function based on the inflammatory condition [5,6]. MPV also indicates the function of platelet, which is central to processes that are involved in coronary heart disease pathophysiology and endothelial dysfunction [7,8]. Platelet parameters can be affected by coronary risk factors including age, obesity, smoking, diabetes mellitus, hypertension, hyperlipidemia metabolic syndrome [6]. Another study demonstrated that MPV can be predicted in patients with stroke [9]. Some other recent studies have presented that elevated MPV is linked with peripheral artery disease and stroke, all of which are related to atherosclerosis on the basis of inflammation [5]. Previous studies demonstrated an association between the long-term mortality after non-ST-segment elevation myocardial infarction and the peripheral blood platelet indices including the MPV, platelet count, and the MPV/P ratio [10]. It can also be affected by thyroid and rheumatic diseases [11,12], malignancy and medications such as anticoagulant therapy, statins. So, if the authors had mentioned these factors, it might be useful. MPV is as an important marker of inflammation. Previous study has shown that MPV showed significant differences in patients with hepatic diseases [13]. On the other hand, MPV value was higher in chronic obstructive pulmonary disease patients compare with those of the control group [14,15]. Therefore, if the authors gave information about hepatic function tests and respiratory condition, the results of the present study may be different and stronger. Additionally, it would be better if the authors defined how much time they specified on measuring MPV levels, because the delaying blood sampling can cause abnormal results in MPV measurements. Finally, MPV may be affected by many factors, the routine clinical usage of these parameters may not be reasonable yet. MPV itself alone without other overt inflammatory markers may not give information to clinicians about the chronic endothelial inflammatory condition of the patient at the first look. So, we think that it should be evaluated together with other inflammatory markers. We believe that these findings will guide further studies about MPV as a surrogate marker of endothelial dysfunction and inflammation in patients with DVT. We thank the authors for their contribution.