Skip to main content
British Heart Journal logoLink to British Heart Journal
. 1988 Jun;59(6):663–671. doi: 10.1136/hrt.59.6.663

Raised concentrations of glucose and adrenaline and increased in vivo platelet activation after myocardial infarction.

G A Oswald 1, C C Smith 1, A P Delamothe 1, D J Betteridge 1, J S Yudkin 1
PMCID: PMC1276873  PMID: 2969254

Abstract

Plasma concentration of beta thromboglobulin was used as an index of in vivo platelet activation in 36 patients after acute myocardial infarction. Twelve patients had diabetes, seven had pulmonary oedema or cardiogenic shock (pump failure) or both, and 17 had uncomplicated infarcts. On the first day of admission, concentrations of beta thromboglobulin were higher in the patients with diabetes and those with pump failure than in those with uncomplicated infarcts. Concentrations of beta thromboglobulin in the non-diabetic patients were studied by multiple regression analysis and were significantly associated with plasma concentrations of adrenaline, pump failure, and glucose but not with noradrenaline or infarct size. When all subjects were considered together, glucose, adrenaline, and pump failure were associated with the beta thromboglobulin concentration but diabetes was without significant effect. Hyperglycaemia and raised plasma adrenaline concentration after myocardial infarction may activate platelets, and this could contribute to poor outcome in such patients.

Full text

PDF
667

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Betteridge D. J., Zahavi J., Jones N. A., Shine B., Kakkar V. V., Galton D. J. Platelet function in diabetes mellitus in relationship to complications, glycosylated haemoglobin and serum lipoproteins. Eur J Clin Invest. 1981 Aug;11(4):273–277. doi: 10.1111/j.1365-2362.1981.tb02116.x. [DOI] [PubMed] [Google Scholar]
  2. Borsey D. Q., Dawes J., Fraser D. M., Prowse C. V., Elton R. A., Clarke B. F. Plasma beta-thromboglobulin in diabetes mellitus. Diabetologia. 1980 May;18(5):353–357. doi: 10.1007/BF00276813. [DOI] [PubMed] [Google Scholar]
  3. Boyle D. M., Barber J. M., McIlmoyle E. L., Salathia K. S., Evans A. E., Cran G., Elwood J. H., Shanks R. G. Effect of very early intervention with metoprolol on myocardial infarct size. Br Heart J. 1983 Mar;49(3):229–233. doi: 10.1136/hrt.49.3.229. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Burrows A. W., Chavin S. I., Hockaday T. D. Plama-thromboglobulin concentrations in diabetes mellitus. Lancet. 1978 Feb 4;1(8058):235–237. doi: 10.1016/s0140-6736(78)90482-8. [DOI] [PubMed] [Google Scholar]
  5. Campbell I. W., Dawes J., Fraser D. M., Pepper D. S., Clarke B. F., Duncan L. J., Cash J. D. Plasma beta-thromboglobulin in diabetes mellitus. Diabetes. 1977 Dec;26(12):1175–1177. doi: 10.2337/diab.26.12.1175. [DOI] [PubMed] [Google Scholar]
  6. Clark R. S., English M., McNeill G. P., Newton R. W. Effect of intravenous infusion of insulin in diabetics with acute myocardial infarction. Br Med J (Clin Res Ed) 1985 Aug 3;291(6491):303–305. doi: 10.1136/bmj.291.6491.303. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. DeWood M. A., Spores J., Notske R., Mouser L. T., Burroughs R., Golden M. S., Lang H. T. Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction. N Engl J Med. 1980 Oct 16;303(16):897–902. doi: 10.1056/NEJM198010163031601. [DOI] [PubMed] [Google Scholar]
  8. Douglas J. T., Lowe G. D., Forbes C. D., Prentice C. R. Plasma fibrinopeptide A and beta-thromboglobulin in patients with chest pain. Thromb Haemost. 1983 Aug 30;50(2):541–542. [PubMed] [Google Scholar]
  9. Fitzgerald D. J., Roy L., Catella F., FitzGerald G. A. Platelet activation in unstable coronary disease. N Engl J Med. 1986 Oct 16;315(16):983–989. doi: 10.1056/NEJM198610163151602. [DOI] [PubMed] [Google Scholar]
  10. Fuller J. H., Keen H., Jarrett R. J., Omer T., Meade T. W., Chakrabarti R., North W. R., Stirling Y. Haemostatic variables associated with diabetes and its complications. Br Med J. 1979 Oct 20;2(6196):964–966. doi: 10.1136/bmj.2.6196.964. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Gwilt D. J., Petri M., Lamb P., Nattrass M., Pentecost B. L. Effect of intravenous insulin infusion on mortality among diabetic patients after myocardial infarction. Br Heart J. 1984 Jun;51(6):626–630. doi: 10.1136/hrt.51.6.626. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Gwilt D. J., Petri M., Lewis P. W., Nattrass M., Pentecost B. L. Myocardial infarct size and mortality in diabetic patients. Br Heart J. 1985 Nov;54(5):466–472. doi: 10.1136/hrt.54.5.466. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Haines A. P., Howarth D., North W. R., Goldenberg E., Stirling Y., Meade T. W., Raftery E. B., Millar Craig M. W. Haemostatic variables and the outcome of myocardial infarction. Thromb Haemost. 1983 Dec 30;50(4):800–803. [PubMed] [Google Scholar]
  14. Hamsten A., Wiman B., de Faire U., Blombäck M. Increased plasma levels of a rapid inhibitor of tissue plasminogen activator in young survivors of myocardial infarction. N Engl J Med. 1985 Dec 19;313(25):1557–1563. doi: 10.1056/NEJM198512193132501. [DOI] [PubMed] [Google Scholar]
  15. Henriksson P., Edhag O., Edlund A., Jansson B., Lantz B., Nyqvist O., Sarby B., Wennmalm A. A role for platelets in the process of infarct extension? N Engl J Med. 1985 Dec 26;313(26):1660–1661. [PubMed] [Google Scholar]
  16. Henriksson P., Wennmalm A., Edhag O., Vesterqvist O., Green K. In vivo production of prostacyclin and thromboxane in patients with acute myocardial infarction. Br Heart J. 1986 Jun;55(6):543–548. doi: 10.1136/hrt.55.6.543. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Hughes A., Daunt S., Vass G., Wickes J. In vivo platelet activation following myocardial infarction and acute coronary ischaemia. Thromb Haemost. 1982 Oct 29;48(2):133–135. [PubMed] [Google Scholar]
  18. Husband D. J., Alberti K. G., Julian D. G. Methods for the control of diabetes after acute myocardial infarction. Diabetes Care. 1985 May-Jun;8(3):261–267. doi: 10.2337/diacare.8.3.261. [DOI] [PubMed] [Google Scholar]
  19. Jaffe A. S., Spadaro J. J., Schechtman K., Roberts R., Geltman E. M., Sobel B. E. Increased congestive heart failure after myocardial infarction of modest extent in patients with diabetes mellitus. Am Heart J. 1984 Jul;108(1):31–37. doi: 10.1016/0002-8703(84)90541-6. [DOI] [PubMed] [Google Scholar]
  20. Kaplan K. L., Owen J. Plasma levels of beta-thromboglobulin and platelet factor 4 as indices of platelet activation in vivo. Blood. 1981 Feb;57(2):199–202. [PubMed] [Google Scholar]
  21. Killip T., 3rd, Kimball J. T. Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients. Am J Cardiol. 1967 Oct;20(4):457–464. doi: 10.1016/0002-9149(67)90023-9. [DOI] [PubMed] [Google Scholar]
  22. Knudsen J. B., Gormsen J., Skagen K., Amtorp O. Changes in platelet functions, coagulation and fibrinolysis in uncomplicated cases of acute myocardial infarction. Thromb Haemost. 1980 Feb 29;42(5):1513–1522. [PubMed] [Google Scholar]
  23. Ludlam C. A., O'Brien J. R., Bolton A. E., Etherington M. A comparison between the plasma concentration of immunologically assayed platelet factor 4 and beta-thromboglobulin and the heparin thrombin clotting time. Thromb Res. 1979;15(3-4):523–530. doi: 10.1016/0049-3848(79)90158-0. [DOI] [PubMed] [Google Scholar]
  24. Mills D. C., Roberts G. C. Effects of adrenaline on human blood platelets. J Physiol. 1967 Nov;193(2):443–453. doi: 10.1113/jphysiol.1967.sp008369. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Mustand J. F., Packham M. A. Platelets and diabetes mellitus. N Engl J Med. 1984 Sep 6;311(10):665–667. doi: 10.1056/NEJM198409063111010. [DOI] [PubMed] [Google Scholar]
  26. O'Brien J. R., Etherington M. D., Shuttleworth R. D., Calwell W. H. Platelet function in acute myocardial infarction patients compared with controls. Thromb Haemost. 1980 Oct 31;44(2):96–99. [PubMed] [Google Scholar]
  27. Ong L., Reiser P., Coromilas J., Scherr L., Morrison J. Left ventricular function and rapid release of creatine kinase MB in acute myocardial infarction. Evidence for spontaneous reperfusion. N Engl J Med. 1983 Jul 7;309(1):1–6. doi: 10.1056/NEJM198307073090101. [DOI] [PubMed] [Google Scholar]
  28. Oswald G. A., Corcoran J. S., Patterson D. L., Yudkin J. S. The extent of coronary artery disease in diabetic patients with myocardial infarction: an ECG study. Diabet Med. 1986 Nov-Dec;3(6):541–544. doi: 10.1111/j.1464-5491.1986.tb00811.x. [DOI] [PubMed] [Google Scholar]
  29. Oswald G. A., Smith C. C., Betteridge D. J., Yudkin J. S. Determinants and importance of stress hyperglycaemia in non-diabetic patients with myocardial infarction. Br Med J (Clin Res Ed) 1986 Oct 11;293(6552):917–922. doi: 10.1136/bmj.293.6552.917. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Oswald G. A., Yudkin J. S. Hyperglycaemia following acute myocardial infarction: the contribution of undiagnosed diabetes. Diabet Med. 1987 Jan-Feb;4(1):68–70. doi: 10.1111/j.1464-5491.1987.tb00833.x. [DOI] [PubMed] [Google Scholar]
  31. Pengo V., Boschello M., Prandoni P., Schiavon R., Bellotto F., Schivazappa L., Dalla Volta S. Enhanced "in vitro" release of platelet alpha-granules after acute myocardial infarction (AMI). Thromb Haemost. 1985 Aug 30;54(2):544–546. [PubMed] [Google Scholar]
  32. Pumphrey C. W., Dawes J. Plasma beta-thromboglobulin as a measure of platelet activity. Effect of risk factors and findings in ischemic heart disease and after acute myocardial infarction. Am J Cardiol. 1982 Dec;50(6):1258–1261. doi: 10.1016/0002-9149(82)90459-3. [DOI] [PubMed] [Google Scholar]
  33. Rasi V., Ikkala E., Torstila I. Plasma beta-thromboglobulin in acute myocardial infarction. Thromb Res. 1982 Feb 1;25(3):203–212. doi: 10.1016/0049-3848(82)90239-0. [DOI] [PubMed] [Google Scholar]
  34. Rutherford W. H. Sequelae of concussion caused by minor head injuries. Lancet. 1977 Jan 1;1(8001):1–4. doi: 10.1016/s0140-6736(77)91649-x. [DOI] [PubMed] [Google Scholar]
  35. Sakaguchi K., Hattori R., Yui Y., Takatsu Y., Susawa T., Yui N., Nonogi H., Tamaki S., Kawai C. Altered platelet alpha 2 adrenoreceptor in acute myocardial infarction and its relation to plasma catecholamine concentrations. Br Heart J. 1986 May;55(5):434–438. doi: 10.1136/hrt.55.5.434. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Saniabadi A. R., Lowe G. D., Barbenel J. C., Forbes C. D. A comparison of spontaneous platelet aggregation in whole blood with platelet rich plasma: additional evidence for the role of ADP. Thromb Haemost. 1984 Feb 28;51(1):115–118. [PubMed] [Google Scholar]
  37. Silver M. D., Baroldi G., Mariani F. The relationship between acute occlusive coronary thrombi and myocardial infarction studied in 100 consecutive patients. Circulation. 1980 Feb;61(2):219–227. doi: 10.1161/01.cir.61.2.219. [DOI] [PubMed] [Google Scholar]
  38. Smith C. C., Curtis L. D., Delamothe A. P., Prichard B. N., Betteridge D. J. The distribution of catecholamines between platelets and plasma in normal human subjects. Clin Sci (Lond) 1985 Jul;69(1):1–6. doi: 10.1042/cs0690001. [DOI] [PubMed] [Google Scholar]
  39. Smitherman T. C., Milam M., Woo J., Willerson J. T., Frenkel E. P. Elevated beta thromboglobulin in peripheral venous blood of patients with acute myocardial ischemia: direct evidence for enhanced platelet reactivity in vivo. Am J Cardiol. 1981 Sep;48(3):395–402. doi: 10.1016/0002-9149(81)90065-5. [DOI] [PubMed] [Google Scholar]
  40. Stratton J. R., Malpass T. W., Ritchie J. L., Pfeifer M. A., Harker L. A. Studies of platelet factor 4 and beta thromboglobulin release during exercise: lack of relationship to myocardial ischemia. Circulation. 1982 Jul;66(1):33–43. doi: 10.1161/01.cir.66.1.33. [DOI] [PubMed] [Google Scholar]
  41. Thomas D. P. Effect of catecholamines on platelet aggregation caused by thrombin. Nature. 1967 Jul 15;215(5098):298–299. doi: 10.1038/215298a0. [DOI] [PubMed] [Google Scholar]
  42. Trovati M., Anfossi G., Cavalot F., Vitali S., Massucco P., Mularoni E., Schinco P., Tamponi G., Emanuelli G. Studies on mechanisms involved in hypoglycemia-induced platelet activation. Diabetes. 1986 Jul;35(7):818–825. doi: 10.2337/diab.35.7.818. [DOI] [PubMed] [Google Scholar]
  43. Woods B. P., Dennehy A., Clarke N. Some observations on the preparation of platelet-rich plasma. Thromb Haemost. 1976 Nov 30;36(2):302–310. [PubMed] [Google Scholar]
  44. Yudkin J. S., Oswald G. A. Determinants of hospital admission and case fatality in diabetic patients with myocardial infarction. Diabetes Care. 1988 Apr;11(4):351–358. doi: 10.2337/diacare.11.4.351. [DOI] [PubMed] [Google Scholar]
  45. Zammit Maempel J. V. Effect of diabetes on the course of acute myocardial infarction in Malta. Isr J Med Sci. 1978 Apr;14(4):424–431. [PubMed] [Google Scholar]
  46. van Hulsteijn H., Kolff J., Briët E., van der Laarse A., Bertina R. Fibrinopeptide A and beta thromboglobulin in patients with angina pectoris and acute myocardial infarction. Am Heart J. 1984 Jan;107(1):39–45. doi: 10.1016/0002-8703(84)90131-5. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES