Mean platelet volume (MPV) is increased in chronic heart failure (CHF) and is an independent predictor of mortality in CHF patients. It is not known whether enhanced external counterpulsation (EECP) therapy leads to decreased MPV values or not. The purpose of this study was to examine the effects of EECP on platelet count and MPV values and to assess the influence of MPV on the risk of death and recurrent ischemic events in ischemic CHF patients. A total of 68 ischemic heart failure patients with CHF symptoms and refractory angina pectoris were included in the study, 47 consecutive patients (39 males and eight females) aged 44-82 years. Although follow-up period started after completion of EECP in treated patients, control group follow-up started at the end of 7-week treatment without EECP. All patients were monitored for a mean duration of 13 +/- 8 months (range, 1-36 months). The primary endpoints of the study were effects of EECP treatment on platelets after treatment period (7 weeks) and the recurrence of ischemic events. Secondary endpoint was cardiovascular death during the follow-up period. We observed a significant increase in platelet count and decrease in MPV levels (P=0.044 and P=0.004, respectively) in the control group. There were no significant differences in platelet count and MPV levels in the EECP group (P>0.05). After the treatment period, New York Heart Association functional classification (2.60 +/- 0.75 vs. 1.72 +/- 0.68, P<0.001) and Canadian Cardiovascular Society functional classification of angina (2.50 +/- 0.90 vs. 1.60 +/- 0.74, P<0.001) improved in patients with EECP treatment. In our study, we found that EECP therapy had a neutral effect on MPV values and platelet count Blood Coagul Fibrinolysis 23:127-131 (C) 2012 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.