Mean platelet volume as a translational biomarker for cardiovascular risk stratification with perspectives for medical education: A systematic review

Objective: To evaluate the prognostic value of mean platelet volume (MPV) for cardiovascular risk stratification in settings with limited resources. Methods: We conducted a comprehensive systematic review in accordance with the PRISMA 2020 guidelines (PROSPERO registration number: CRD420251156089). From January 2019 to December 2024, we searched five databases (PubMed, Scopus, Web of Science, SciELO and LILACS) for observational studies linking MPV to cardiovascular outcomes. The methodological quality of the studies was assessed using the STROBE criteria, and the certainty of the evidence was assessed using the GRADE approach. Results: Thirteen studies involving 3,085 participants were included. Of these, 12 (92.3%) reported statistically significant associations between elevated mean platelet volume (MPV) and an increased risk of acute myocardial infarction, stroke, and thromboembolism. MPV values in patients experiencing acute events (8.4–10.7 fL) were consistently higher than in the control group. Derived indices, particularly the MPV-to-lymphocyte ratio, demonstrated superior predictive utility compared to MPV alone. However, critical limitations included substantial heterogeneity in the cut-off point (7.45–12 fL), pre-analytical variability and the complete absence of Latin American populations. The overall certainty of the evidence was classified as VERY LOW. Conclusion: Although there is a consistent predictive signal across worldwide cohorts, its current application in clinical practice is prohibited by the VERY LOW certainty of evidence, which is caused by high pre-analytical heterogeneity and a total lack of Latin American data. These results show that MPV should be prioritized for standardized validation studies rather than being used right away in clinical settings.