New 'platelet score' being used to gauge risk of stroke, heart attack

An experimental genetic test can gauge a person's risk of developing potentially deadly blood clots, researchers report.

People who scored high on the test had more than double the rate of heart attack , stroke and major amputation after they underwent a procedure to reopen blocked arteries in their legs, results showed.

The test assesses whether a person's platelets are "hyperreactive," and thus prone to abnormal clotting that blocks arteries, according to the report published Tuesday in the journal Nature Communications .

"Our results demonstrate that our new platelet-centric scoring system can ... reliably predict platelet hyperreactivity and the related risk of cardiovascular events," said researcher Dr. Jeffrey Berger , director of the Center for the Prevention of Cardiovascular Disease at NYU Grossman School of Medicine in New York City.

The platelet score can detect hyperreactivity in apparently healthy patients as well as in sick people on the verge of a heart attack, researchers said.

"Physicians currently prescribe aspirin, a medication that counters platelet activity, to patients based on available risk factors, including high cholesterol or high blood pressure, which are not directly related to platelet function," Berger explained in an NYU news release.

However, aspirin comes with its own risks, increasing a person's odds of dangerous bleeding, the researchers noted.

The new test "promises to help physicians confine anti-platelet treatment to the people most likely to benefit: those with platelet hyperreactivity," Berger added.

Platelets, the smallest blood cells, bind together to form clots whenever they detect bleeding in injured blood vessels.

Heart doctors have long known that platelets become hyperreactive in some people, creating clots that can cause heart attacks and strokes or block blood flow to the legs, researchers said in background notes.

But routine tests currently available to assess platelets' propensity to clot aren't accurate enough to be very helpful, they noted.

To come up with a new test, researchers ran genetic tests on a group of patients with diagnosed platelet hyperreactivity, identifying 451 genes that appeared to differ significantly in them versus healthy people.

These genetic differences were used to create a Platelet Reactivity ExpresSion Score (PRESS) for each patient.

The research team then used the PRESS test to assess clotting risk for a group of 254 people who had undergone a procedure to reopen blocked arteries in their legs.

The test revealed that nearly 18% of the patients had hyperreactive platelets.

Those patients had greater than twice the risk of heart attack, stroke, major leg blood clots or leg amputation within a month of the procedure, compared to those whose PRESS test results showed no hyperreactivity, researchers said.

The team also used PRESS to assess platelet hyperreactivity among a separate group of women suffering from clogged arteries in their legs. Results showed that those with elevated scores were 90% more likely to have a heart attack or stroke.

"In current practice, anti-platelet therapy is not routinely recommended for the prevention of a first heart attack or stroke, but a platelet-based test would help to identify patients at highest risk, and those who would benefit most from anti-platelet therapy to prevent a cardiovascular event," said researcher Tessa Barrett , an assistant professor in the departments of medicine and pathology at NYU Langone. "Our score has the potential to further personalize cardiovascular disease risk prevention."

More information

Johns Hopkins Medicine has more about platelets .

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