Advertisement

Research in Clinic and Laboratory

, Volume 20, Issue 3, pp 197–202 | Cite as

Elevation of thrombin-antithrombin complexes during thrombolytic therapy in patients with myocardial infarction

  • Armando Tripodi
  • Biancamaria Bottasso
  • Pier Mannuccio Mannucci
Original Contributions
  • 20 Downloads

Summary

In patients with acute myocardial infarction (AMI) treated with streptokinase (SK) or recombinant tissue-type plasminogen activator (rtPA) we found high levels of thrombin-antithrombin (TAT) complexes signalling a significant activation of the coagulation cascade. In the SK-treated group the median pretreatment TAT complexes levels were 5.0 µg/l and in all patients, whatever the pretreatment level, TAT complexes increased following treatment. A statistically significant increase (medians = 20.3 and 12.0 µg/l) was observed 90 and 180 min after starting SK. The mean pretreatment level in the rtPA-treated group was also 5.0 µg/l and in all but one patients TAT complexes increased following treatment. A statistically significant increase (medians = 37.0 and 30.5 µg/l) was observed 90 and 180 min after starting rtPA. There was no statistically significant difference between TAT complexes in the two groups of patients either before or 90 min after treatment, whereas at 180 min the median concentration of TAT complexes was significantly higher for rtPA- than for SK-treated patients. We did not find an association between coronary vessels patency after thrombolysis and concentrations of TAT complexes; however, the rate of occluded vessels was very low (4 out of 30 patients), so that a difference was perhaps lost due to the insufficient size of the sample. In conclusion, we found thrombin activity during thrombolytic therapy in patients with AMI. There is no important difference in this respect between rtPA and SK. Whether or not this phenomenon is responsible for early rethrombosis remains to be explored by larger studies.

Key-words

Myocardial infarction Streptokinase Thrombin-antithrombin complexes Thrombolysis Tissue-plasminogen activator 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bloom A. L.: The release of thrombin from fibrin by fibrinolysis — Brit. J. Haematol.82, 129, 1962.CrossRefGoogle Scholar
  2. 2.
    Collen D., Topol E. J., Tiefenbrunn A. J., Gold H. K., Weisfeldt M. L., Sobel B. E., Leinback R. C., Brinker J. A., Ludbrook P. A., Yasuda T., Bulkey B. H., Robinson A. K., Hutter A. M., Bell W. R., Spadare J. J., Khaw B. A., Grossbard E. B.: Coronary thrombolysis with recombinant human tissue type plasminogen activator: a prospective randomized placebocontrolled trial — Circulation70, 1012, 1984.PubMedGoogle Scholar
  3. 3.
    Gulba D., Barthels M., Reil G. H., Lichtlen P. R.: Thrombin/antithrombin III complex level as early prediction of reocclusion after successful thrombolysis — Lancetii, 97, 1988. (Letter).CrossRefGoogle Scholar
  4. 4.
    Hawiger J., Niewiaroski S., Gurewich V., Thomas D. P.: Measurement of fibrinogen and fibrin degradation products in serum by staphylococcal clumping test — J. Lab. clin. Med.75, 93, 1970.PubMedGoogle Scholar
  5. 5.
    Hoek J. A., Sturk A., ten Cate J. W., Lamping R. J., Berends F., Borm J. J. J.: Laboratory and clinical evaluation of an assay of thrombin/antithrombin III complexes in plasma — Clin. Chem.34, 2058, 1988.PubMedGoogle Scholar
  6. 6.
    Magnani B.: Plasminogen Activator Italian Multicenter Study (PAIMS): Comparison of intravenous recombinant single-chain human tissue-type plasminogen activator (rt-PA) with intravenous streptokinase in acute myocardial infarction — J. Amer. Coll. Cardiol.13, 19, 1989.CrossRefGoogle Scholar
  7. 7.
    Nossel H. L., Yudelman I., Canfield R. E., Butler V. P., Spanondis K., Wilner G. D., Qureshi G. D.: Measurement of fibrinopeptide A in human blood — J. clin. Invest.54, 43, 1974.PubMedCrossRefGoogle Scholar
  8. 8.
    Owen J., Friedman K. D., Grossman B. A., Wilkins C., Berke A. D., Powers E. R.: Thrombolytic therapy with tissue type plasminogen activator or streptokinase induce transient thrombin activity — Blood72, 616, 1988.PubMedGoogle Scholar
  9. 9.
    Pelzer H., Schwarz A., Heimburger N.: Determination of human thrombin-antithrombin III complex in plasma with an enzyme-linked immunosorbent assay — Thrombos. Haemostas.59, 101, 1988.Google Scholar
  10. 10.
    Seitz R., Blanke H., Pratorius G., Strauer B. E., Egbring R.: Increased thrombin activity during thrombolysis — Thrombos. Haemostas.59, 541, 1988.Google Scholar
  11. 11.
    Shifman M. A., Pizzo S. V.: Thein vivo metabolism of antithrombin III and antithrombin III complexes — J. biol. Chem.257, 3243, 1983.Google Scholar
  12. 12.
    Teitel G. M., Bauer K. A., Lau H. K., Rosenberg R. D.: Studies of the prothrombin activation pathway utilizing radioimmunoassays for the F2/F1+2 fragment and thrombin-antithrombin complex — Blood59, 1086, 1982.PubMedGoogle Scholar
  13. 13.
    Vermylen C., De Vreker R. A., Verstraete M.: A quick quantitative enzymatic fibrinogen assay method: the fibrin polymerization time (FPT) — Clin. chim. Acta8, 428, 1963.CrossRefGoogle Scholar
  14. 14.
    Weitz J. I., Cruickshank M. K., Thong B., Leslie B., Levine M. N., Ginsberg J., Eckhardt T.: Human tissue-type plasminogen activator releases fibrinopeptides A and B from fibrinogen — J. clin. Invest.82, 1700, 1988.PubMedCrossRefGoogle Scholar

Copyright information

© Casa Editrice «Il Ponte» 1990

Authors and Affiliations

  • Armando Tripodi
    • 1
  • Biancamaria Bottasso
    • 1
  • Pier Mannuccio Mannucci
    • 1
  1. 1.Centro Emofilia e Trombosi Angelo Bianchi Bonomi Istituto di Medicina InternaUniversità degli Studi di Milano Ospedale MaggioreMilanoItalia

Personalised recommendations