Platelet-vessel wall interactions in individuals who smoke cigarettes.

Our studies have shown that there an increased excretion of urinary metabolites of thromboxane A2 in healthy, young male chronic smokers. This arachidonic acid metabolite from platelets reflects evidence of increased activation in vivo. These data contrast with the ex vivo study of platelets in chronic smokers and point out the fact that selection of cells for ex vivo study may not appropriately reflect the in vivo pathophysiologic situation. The platelet activation related to chronic smoking appears to result from both a direct, non-sympathoadrenally mediated activation which is rapidly inducible and reversible as well as a more persistent activation which long outlasts the smoke exposure. This latter mechanism appears to result from persistent vascular damage as reflected by the enhanced prostacyclin metabolite excretion. The acute, direct effect of smoking on the platelet appears to be a minor component of the altered platelet function. This latter inference may account for the inability in some studies to observe a small incremental, acute change superimposed on the persistently increased platelet reactivity secondary to the enhanced interactions with a damaged vasculature.