Original Article

Polycystic Ovary Syndrome: Focus on Platelets and Prothrombotic Risk

Authors: Constantin A. Dasanu, MD, PhD, Bernard A. Clark, III, MD, Thomas E. Ichim, PhD, Doru T. Alexandrescu, MD

Abstract

Objectives: Subjects with polycystic ovary syndrome (PCOS) were shown to carry an increased long-term cardiovascular risk. Systemic inflammation and reactive leukocytosis have also been described in PCOS. Recent research suggests the presence of an increased thrombotic risk in these patients.


Methods: We describe a cohort of PCOS patients presenting with persistent thrombocytosis. Our cohort included women aged 20–37 who also had moderate leukocytosis and neutrophilia. They showed normal mean platelet volume and platelet aggregation. We excluded any myeloproliferative conditions in all patients.


Results: The mean platelet count and standard deviation (SD) at presentation were 587 ± 61 × 109/L (normal 140–440 × 109/L). Median C-reactive protein (CRP) was 1.66 (range 1.2–2.2, normal <1 mg/dL). The platelet counts did not correlate with the CRP levels in our patients (Pearson correlation coefficient 0.171 and 0.170, respectively, P = 0.08).


Conclusion: While the inflammatory state of PCOS could play a role in triggering an increased platelet count, the persistent thrombocytosis in our patients did not correlate with the CRP levels. Therefore, from an etiological perspective, thrombocytosis appears to be at least partially independent from the classical pathways of systemic inflammation. The preexisting procoagulant state in PCOS due to coagulation cascade stimulation, platelet activation, and endothelial dysfunction may be further fueled by the presence of persistent thrombocytosis. We propose a unique model for cardiovascular risk assessment in women with PCOS to include not only the classic cardiovascular risk factors, but also the parameters related to the proinflammatory and procoagulant tendencies manifested in PCOS.


Key Points


* Reactive leukocytosis has previously been described in polycystic ovary syndrome (PCOS).


* PCOS was also shown to be associated with severe platelet and endothelial dysfunction in several studies.


* We describe a cohort of PCOS patients presenting with moderate neutrophilia and persistent thrombocytosis.


* The increased platelet counts in these patients did not correlate with the C-reactive protein levels and may independently contribute to the procoagulant tendencies in patients with PCOS.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Chang AY, Wild RA. Characterizing cardiovascular risk in women with polycystic ovary syndrome: more than the sum of its parts? Semin Reprod Med 2009;27:299–305.
 
2. Mak W, Dokras A. Polycystic ovarian syndrome and the risk of cardiovascular disease and thrombosis. Semin Thromb Hemost 2009;35:613–620.
 
3. Snoep JD, Roest M, Barendrecht AD, et al. High platelet reactivity is associated with myocardial infarction in premenopausal women: a population-based case-control study. J Thromb Haemost 2010;8:906–913.
 
4. Rajendran S, Willoughby SR, Chan WP, et al. Polycystic ovary syndrome is associated with severe platelet and endothelial dysfunction in both obese and lean subjects. Atherosclerosis 2009;204:509–514.
 
5. Schneider DJ. Abnormalities of coagulation, platelet function, and fibrinolysis associated with syndromes of insulin resistance. Coron Artery Dis 2005;16:473–476.
 
6. Kebapcilar L, Taner CE, Kebapcilar AG, et al. High mean platelet volume, low-grade systemic coagulation and fibrinolytic activation are associated with androgen and insulin levels in polycystic ovary syndrome. Arch Gynecol Obstet 2009;280:187–193.
 
7. Dereli D, Ozgen G, Buyukkececi F, et al. Platelet dysfunction in lean women with polycystic ovary syndrome and association with insulin sensitivity. J Clin Endocrinol Metab 2003;88:2263–2268.
 
8. Yilmaz M, Biri A, Bukan N, et al. Levels of lipoprotein and homocysteine in non-obese and obese patients with polycystic ovary syndrome. Gynecol Endocrinol 2005;20:258–263.
 
9. Orio F Jr, Palomba S, Cascella T, et al. The increase of leukocytes as a new putative marker of low-grade chronic inflammation and early cardiovascular risk in polycystic ovary syndrome. J Clin Endocrinol Metab 2005;90:2–5.
 
10. Ibáñez L, Jaramillo AM, Ferrer A, et al. High neutrophil count in girls and women with hyperinsulinaemic hyperandrogenism: normalization with metformin and flutamide overcomes the aggravation by oral contraception. Hum Reprod 2005;20:2457–2462.
 
11. Diamanti-Kandarakis E, Paterakis T, Kandarakis HA. Indices of low-grade inflammation in polycystic ovary syndrome. Ann N Y Acad Sci 2006;1092:175–186.
 
12. Samy N, Hashim M, Sayed M, et al. Clinical significance of inflammatory markers in polycystic ovary syndrome: their relationship to insulin resistance and body mass index. Dis Markers 2009;26:163–170.
 
13. González F, Rote NS, Minium J, et al. Evidence of proatherogenic inflammation in polycystic ovary syndrome. Metabolism 2009;58:954–962.
 
14. Machin SJ, Briggs C. Mean platelet volume: a quick, easy determinant of thrombotic risk? J Thromb Haemost 2010;8:146–147.
 
15. Repaci A, Gambineri A, Pasquali R. The role of low-grade inflammation in the polycystic ovary syndrome. Mol Cell Endocrinol 2010;August 11 [Epub ahead of print].