Stroke remains a leading cause of mortality and long-term disability worldwide, with ischemic stroke constituting the majority of cases. Despite advances in neuroimaging and acute management, there is a continued need for accessible and reliable biomarkers that may assist in risk stratification, prognostication, and understanding disease mechanisms. Mean platelet volume (MPV), an index of platelet size and activity routinely reported in complete blood counts, has emerged as a potential biomarker in cerebrovascular disease. Larger platelets are metabolically and enzymatically more active, exhibit greater prothrombotic potential, and are associated with enhanced inflammatory responses, all of which are relevant to ischemic stroke pathophysiology.

This article critically examines the biological basis of MPV, its relationship with platelet function, and its association with ischemic stroke severity, subtype, lesion volume, and clinical outcomes. Evidence from epidemiological studies, hospital-based cohorts, and prognostic analyses is synthesized to evaluate whether elevated MPV is associated with worse outcomes in acute ischemic stroke. The interaction of MPV with comorbid conditions such as diabetes mellitus, metabolic syndrome, and cardiovascular disease is also explored. Methodological considerations, including preanalytical and analytical variability in MPV measurement, are discussed as important limitations affecting clinical interpretation.

Overall, current evidence suggests that MPV is associated with stroke risk and may predict severity and functional outcome in selected populations. However, heterogeneity across studies and the absence of standardized cut-off values limit its immediate clinical application. MPV should be viewed as a supportive biomarker that reflects underlying thrombo-inflammatory processes rather than a standalone diagnostic or prognostic tool. Further large-scale, standardized, and prospective studies are required to clarify its role in routine stroke care and to integrate MPV into multimarker approaches for cerebrovascular disease assessment.

Mean platelet volume, ischemic stroke, platelet activation, cerebrovascular disease, prognostic biomarkers, thrombosis

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