Shear-induced Filter Blockage. A Population Based Appraisal of a Method for the Assessment of Platelet, White Cell and von Willebrand Factor Interactions.

Blood behaviour under shear-stress is assessed by a filter method in the Caerphilly Prospective Heart Study. Associations with haemostatic and lifestyle factors in 941 men aged 55 to 69 years are reported. The importance of platelets in filter blockage is confirmed, and roles for white cells and plasma viscosity in determining flow prior to blockage are identified. The aspect of platelet activity involved in blockage appears to be independent of mechanisms mediated by cyclo-oxygenase and adenosine diphosphate. von Willebrand factor however is associated with filter blockage, probably as an inter-platelet ligand. Fibrinogen is not required for blockage. Men regularly consuming alcohol or garlic supplements show reduced blockage, and biochemical mechanisms are suggested which might explain these associations. No effects of aspirin, smoking or consumption of fish oil supplements were noted. Shear-induced filter blockage is a simple method for measuring complex flow-dependent interactions of haemostatic factors. Its application in a wide range of investigations, including epidemiological studies, would appear to be appropriate.

Platelet responses to cardiopulmonary bypass. Assessment by a shear stress activation technique.

Platelet responses before and during cardiopulmonary bypass were studied using a shear stress activation technique. Whole blood was passed through a 10 microns micro-porous filter and the percentage of platelets retained was determined. Retention in control subjects (n = 20, age 62 +/- 11 years) was 65.2 +/- 15.1%. Patients with ischaemic heart disease (n = 20, age 61 +/- 9 years) had significantly higher retention at 82.6 +/- 13.2%, p less than 0.001. In valvular heart disease (n = 15, age 57 +/- 14 years) the retention rate was 43.5 +/- 15.4%, lower than both controls and ischaemic heart disease patients (p less than 0.001). In vitro haemodilution had no significant effect on platelet retention. High retention rates were maintained in patients undergoing coronary artery surgery. During valve surgery retention increased before aortic cross-clamp removal (83.5 +/- 13.4%) compared with baseline values (p less than 0.001) and remained high 24 hours postoperatively (79.6 +/- 9.4%). Platelet retention also increased within 20 minutes of thoracotomy without cardiopulmonary bypass (n = 10, age 57 +/- 8 years, 79.3 +/- 11.6% versus 61.6 +/- 10.9% baseline, p less than 0.01) and remained high 24 hours postoperatively. Significant differences in platelet responses, assessed by shear stress activation, were demonstrated between healthy controls and patients with ischaemic and valvular heart disease. Surgery, with or without extracorporeal circulation, caused a significant increase in platelet retention.