Related Experiment Video
Updated: Jun 9, 2026
Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
Perioperative platelet and monocyte activation in patients with critical limb ischemia
Anne Burdess1, Alastair F Nimmo, Neil Campbell
1Department of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, United Kingdom. anne.burdess@ed.ac.uk
Insights
Patients with critical limb ischemia (CLI) undergoing surgery exhibit elevated platelet and monocyte activation. This activation persists perioperatively, suggesting a need for enhanced antiplatelet therapy to mitigate cardiovascular risks in these high-risk vascular patients.
Area of Science:
- Cardiovascular Science
- Hematology
- Vascular Surgery
Background:
- Critical limb ischemia (CLI) patients face high cardiovascular event rates, especially post-surgery.
- Understanding surgery's impact on platelet and monocyte activation in CLI is crucial.
Purpose of the Study:
- To determine the effect of surgery and vascular disease on in vivo platelet and monocyte activation in CLI patients.
- To compare activation levels in CLI patients with healthy controls and other patient groups.
Main Methods:
- Observational, cross-sectional study at a tertiary referral hospital.
- Measured platelet and monocyte activation using flow cytometry in CLI patients undergoing infrainguinal bypass.
- Compared CLI patients with matched controls, intermittent claudication, acute myocardial infarction, and arthroplasty groups.
Main Results:
- CLI patients showed significantly higher platelet-monocyte aggregates, microparticles, and monocyte CD40 expression compared to intermittent claudication patients.
- Activation levels in CLI patients were comparable or higher than in acute myocardial infarction patients.
- Platelet and monocyte activation markers remained elevated throughout the perioperative period in CLI patients.
Conclusions:
- Surgery for CLI leads to the highest in vivo platelet and monocyte activation levels.
- These activation markers persist throughout the perioperative period in CLI patients.
- Additional antiplatelet therapy may be beneficial for vascular patients with severe CLI during this high-risk period.
Background:
Patients with critical limb ischemia (CLI) have a high rate of adverse cardiovascular events, particularly when undergoing surgery. We sought to determine the effect of surgery and vascular disease on platelet and monocyte activation in vivo in patients with CLI.
Methods:
An observational, cross-sectional study was performed at a tertiary referral hospital in the southeast of Scotland. Platelet and monocyte activation were measured in whole blood in patients with CLI scheduled for infrainguinal bypass and compared with matched healthy controls, patients with chronic intermittent claudication, patients with acute myocardial infarction, and those undergoing arthroplasty (n = 30 per group). Platelet and monocyte activation were quantified using flow cytometric assessment of platelet-monocyte aggregation, platelet P-selectin expression, platelet-derived microparticles, and monocyte CD40 and CD11b expression.
Results:
Compared with those with intermittent claudication, subjects with CLI had increased platelet-monocyte aggregates (41.7% +/- 12.2% vs 32.6% +/- 8.5%, respectively), platelet microparticles (178.7 +/- 106.9 vs 116.9 +/- 53.4), and monocyte CD40 expression (70.0% +/- 12.2% vs 52.4% +/- 15.2%; P < .001 for all). Indeed, these levels were equivalent (P-selectin, 4.4% +/- 2.0% vs 4.9% +/- 2.2%; P > .05) or higher (platelet-monocyte aggregation, 41.7% +/- 12.2% vs 33.6% +/- 7.0%; P < .05; platelet microparticles, 178.7 +/- 106.9 vs 114.4 +/- 55.0/microL; P < .05) than in patients with acute myocardial infarction. All platelet and monocyte activation markers remained elevated throughout the perioperative period in patients with CLI (P < .01) but not those undergoing arthroplasty.
Conclusions:
Patients undergoing surgery for CLI have the highest level of in vivo platelet and monocyte activation, and these persist throughout the perioperative period. Additional antiplatelet therapy may be of benefit in protecting vascular patients with more severe disease during this period of increased risk.
More Related Videos
05:12Intravital Microscopy of Leukocyte-endothelial and Platelet-leukocyte Interactions in Mesenterial Veins in Mice
Published on: August 13, 2015
11:18Real-time Imaging of Heterotypic Platelet-neutrophil Interactions on the Activated Endothelium During Vascular Inflammation and Thrombus Formation in Live Mice
Published on: April 2, 2013
Related Concept Videos
01:22Formation of the Platelet Plug
As the injured blood vessel contracts, endothelial cells undergo contraction, revealing collagen fibers in the basement membrane and underlying connective tissue. Furthermore, the plasma membrane of endothelial cells becomes adhesive, preparing the site for platelet adhesion. Platelets...
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:27Peripheral Artery Disease III: Interprofessional Care
01:18Structure and Function of Platelets
Platelets are continually replenished, circulating in the bloodstream for 9-12 days before being removed by phagocytes, primarily in the spleen. A microliter of circulating blood contains between 150,000 and 450,000 platelets, with...
01:30Peripheral Artery Disease I: Introduction
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...