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Altered Rheological Properties of Blood following Administrations of Tissue Plasminogen Activator and Streptokinase in Patients with Acute Myocardial Infarction

  • Kung-ming Jan
  • Eric Powers
  • Walter Reinhart
  • Andrew Berke
  • Allen Nichols
  • Rita Watson
  • Dennis Reison
  • Allan Schwartz
  • Shu Chien
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 281)

Abstract

Tissue blood flow is determined by rheological properties of blood as well as by vascular resistance. In acute myocardial infarction patients who participated in the TIMI I trial, we compared the effects of recombinant tissue plasminogen activator (rt-PA) and streptokinase (SK) on blood rheological properties and plasma fibrinogen concentration. Blood viscosity was determined by using a coaxial cylinder viscometer at shear rates, γ, of 0.01-200 sec-1. Red blood cell (RBC) deformability was studied by filtration through poly-carbonate microsieves with pore size of 3 and 5 μm. Therapy with rt-PA resulted in slight decreases but statistically significant in blood viscosity from 5.2±0.5 to 4.9±0.4 cP (γ = 52 sec-1), plasma viscosity from 1.36±0.09 to 1.32±0.06 cP, and plasma fibrinogen from 0.26 ± 0.04 to 0.21 ±0.03 g/dl. SK therapy resulted in reductions in blood viscosity from 5.1 ± 0.5 to 4.6 ± 0.3 cP, plasma viscosity from 1.26 ± 0.10 to 1.16 ± 0.03 cP, and fibrinogen from 0.26 ± 0.06 to 0.10 ± 0.05 g/dl. Changes observed with SK were significantly greater than those observed with rt-PA (all p <0.05), and the differences persisted at 10 days after thrombolytic therapy. RBC deformability was similar in the two groups. The greater reduction of blood viscosity after SK than rt-PA suggests that, for a given degree of arterial patency, myocardial blood flow may be better maintained with SK than rt-PA in patients with acute myocardial infarction.

Keywords

Shear Rate Acute Myocardial Infarction Myocardial Blood Flow Thrombolytic Therapy Blood Viscosity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    M. A. DeWood, J. Spores, R. Notske, L. T. Mouser, R. Burroughs, M. S. Golden, and H. T. Lang, Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction. N. Engl. J. Med.,303:897 (1980).PubMedCrossRefGoogle Scholar
  2. 2.
    E. Braunwald, The path to myocardial salvage by thrombolytic therapy. Circulation, 76 (Suppl II):II2 (1987).PubMedGoogle Scholar
  3. 3.
    The TIMI Study Group. The thrombolysis in myocardial infarction (TIMI) trial: Phase I findings. N. Engl. J. Med., 312:932 (1985).Google Scholar
  4. 4.
    Gruppo Italiano per lo Studio della Streptochinasi nell’Infarto Miocardico (GISSI): Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet, 1:397 (1986).Google Scholar
  5. 5.
    The ISAM Study Group. A prospective trial of intravenous streptokinase in acute myocardial infarction (ISAM). N. Engl. J. Med.,314:1465 (1986).CrossRefGoogle Scholar
  6. 6.
    G. V. Martin, M. L. Stadius, K. B. Davis, J. L. Ritchie, F. K. Sheehan, C. Maynard, and J. W. Kennedy. The Western Washington intravenous streptokinase trial; effects of intravenous streptokinase on vessel patency and left ventricular function. Circulation, 74 (Suppl II):II-367 (1986).Google Scholar
  7. 7.
    M. Verstraete. The search for the ideal thrombolytic agent. J. Am. Coll. Cardiol., 10:4B (1987).PubMedCrossRefGoogle Scholar
  8. 8.
    S. Chien. Biophysical behavior of red cells in suspension. In: D. M. Surgenor, editor: The Red Blood Cells, 2nd edition, New York, 1975, Academic Press, vol 2, p. 1031.Google Scholar
  9. 9.
    K. M. Jan, S. Chien, and J. T. Bigger Jr. Observation on blood viscosity changes after acute myocardial infarction. Circulation, 51:1079 (1975).PubMedCrossRefGoogle Scholar
  10. 10.
    J. Dormandy, M. Boyd, and E. Ernst. Red cell filterability after myocardial infarction. Scand. J. Clin. Lab. Invest., 156:195 (1981).CrossRefGoogle Scholar
  11. 11.
    W. Bell. Objectives of thrombolytic therapy in acute myocardial infarction. Am. J. Med., 83(Suppl 2A):11 (1987).PubMedCrossRefGoogle Scholar
  12. 12.
    F. H. Sheehan, E. Braunwald, P. Canner, H. T. Dodge, J. Gore, P. Van Natta, E. R. Passamani, D. O. William, and B. Zaret. The effect of intravenous thrombolytic therapy on left ventricular function: a report on tissue plasminogen activator and streptokinase from the Thrombolysis in Myocardial Infarction (TIMI Phase I) trial. Circulation, 75:817 (1987).PubMedCrossRefGoogle Scholar
  13. 13.
    J. H. Chesebro, G. Knatterud, R. Roberts, J. Borer, L. S. Cohen, J. Dalen, H. T. Dodge, C. K. Francis, D. Hillis, P. Ludbrook J. E. Markis, H. Hueller, E. R. Passamani, E. R. Powers, A. K. Rao, T. Robertson, A. Ross, T. J. Ryan, B. E. Sobel, J. Willerson, D. O. Williams, B. L. Zaret, and E. Braunwald. Thrombolysis in Myocardial Infarction (TIMI) trial, Phase I: a comparison between intravenous plasminogen activator and intravenous streptokinase. Clinical findings through hospital discharge. Circulation, 76:142 (1987).PubMedCrossRefGoogle Scholar
  14. 14.
    A. K. Rao, C. Pratt, A. Berke, A. Jaffe, I. Ockene, T. L. Schreiber, W. R. Bell, G. Knatterud, T. L. Robertson, and M. L. Terrin. Thrombolysis in Myocardial Infarction (TIMI) trial - Phase I: hemorrhagic manifestations and changes in plasma fibrinogen and the fibrinolytic system in patients treated with recombinant tissue plasminogen activator and streptokinase. J. Am. Coll. Cardiol., 11:1 (1988).PubMedCrossRefGoogle Scholar
  15. 15.
    S. Chien, R. J. Dellenback, S. Usami, and M. I. Gregersen. Plasma trapping in hematocrit determination: Differences among animal species. Proc. Soc. Exp. Biol. Med., 119:1155 (1965).PubMedGoogle Scholar
  16. 16.
    B. S. Neuhausen, and D. M. Rioch. The refractometric determination of serum protein. J. Biol. Chem., 55:353 (1923).Google Scholar
  17. 17.
    O. D. Ratnoff, and C. Menzie. A new method for the determination of fibrinogen in small sample of plasma. J. Lab. Clin. Med., 37:316 (1951).PubMedGoogle Scholar
  18. 18.
    S. Chien, S. Usami, R. J. Dellenback, and C. A. Bryant. Comparative hemorheologyhematological implications of species differences in blood viscosity. Biorheology,8:35 (1971).PubMedGoogle Scholar
  19. 19.
    S. Chien, and K. M. Jan. Ultrastructural basis of the mechanism of rouleaux formation. Microvasc. Res.,5:155 (1973).PubMedCrossRefGoogle Scholar
  20. 20.
    W. H. Reinhart, S. Usami, E. A. Schmalzer, M. M. L. Lee, and S. Chien. Evaluation of red blood cell filterability test: Influence of pore size, hematocrit level, and flow rate. J. Lab. Clin. Med.,104:501 (1984).PubMedGoogle Scholar
  21. 21.
    E. A. Schmalzer, R. Skalak, S. Usami, M. Vayo, and S. Chien. Influence of red cell concentration on filtration of blood cell suspensions. Biorheology, 20;29 (1983).PubMedGoogle Scholar
  22. 22.
    S. Chien. Blood rheology and its relation to flow resistance and transcapillary exchange, with special reference to shock. Advances in Microcir.,2:89 (1969).Google Scholar
  23. 23.
    A. D. McLachlin, J. A. McLachlin, T. A. Jory, and E. C. Rawling. Venous stasis in the lower extremities. Ann. Surg., 152:678 (1960).PubMedCrossRefGoogle Scholar
  24. 24.
    I. Weinberger, J. Fuchs, A. Tobul, Z. Rotenberg, and J. Agmon. Plasma viscosity changes during acute myocardial infarction. Circulation, 72(Suppl III)::III-417 (1985).Google Scholar
  25. 25.
    R. J. Gordon, G. K. Snyder, H. Tritel, and W. J. Taylor. Potential significance of plasma viscosity and hematocrit in myocardial ischemia. Am. Heart J., 87:175 (1974).PubMedCrossRefGoogle Scholar
  26. 26.
    H. Neuhof, D. Hey, E. Glaser, H. Wolf, and H. G. Lasch. Hemodynamic reactions induced by streptokinase therapy in patients with acute myocardial infarction. Eur. J. Intensive Care Med.,1:27 (1975).CrossRefGoogle Scholar
  27. 27.
    The European Cooperative Study Group. Streptokinase in acute myocardial infarction extended report of the European Cooperative Trial. Acta. Med. Scand, Supple, 648:7 (1981).Google Scholar
  28. 28.
    G. J. Davies, S. Chierchia, and A. Maseri Prevention of myocardial infarction by very early treatment with intracoronary strepkinase. Some clinical observation. N. Engl. J. Med., 311:1488 (1984).PubMedCrossRefGoogle Scholar
  29. 29.
    R. N. A. Gasser, F. Dienstl, B. Puschendorf, S. Hauptlorenz, M. Moll, and E. Dworzak. New perspectives on the function of coronary artery spasm in acute myocardial infarction: the thromboischemic reentry mechanism. Angiology 37:880 (1986).PubMedGoogle Scholar
  30. 30.
    H. Blanke, M. Cohen, K. R. Karsch, R. Fagerstrom, and K. P. Rentrop. Prevalence and significance of residual flow to the infarct zone during the acute phase of myocardial infarction. J. Am. Coll. Cardiol.,5:827 (1985).PubMedCrossRefGoogle Scholar
  31. 31.
    W. Wende, H. W. Stühlen, J. Meyer, W. Bleifeld, H. Holzhüter, and E. Wenzel. Influence of a streptokinase-induced fibrinolysis on the extent of the acute experimental myocardial infarction. Klin. Wochenschr., 53:755 (1975).PubMedCrossRefGoogle Scholar
  32. 32.
    A. M. Ehrly. Rheological changes due to fibrinolytic therapy. In: K. Messmer, H. Schmid-Schönbein, editor: Hemodilution. Theoretical Basis and Clinical Application. Basel, 1972, S. Karger, p. 289.Google Scholar
  33. 33.
    H. D. Bruhn, P. Jipp, and I. Hagenah. Thrombolytic treatment of chronic obturations of the pelvic arteries and the arteries of the lower extremities. Med. Klin., 68:1430 (1973).PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1990

Authors and Affiliations

  • Kung-ming Jan
    • 1
  • Eric Powers
    • 2
  • Walter Reinhart
    • 1
  • Andrew Berke
    • 2
  • Allen Nichols
    • 2
  • Rita Watson
    • 2
  • Dennis Reison
    • 2
  • Allan Schwartz
    • 2
  • Shu Chien
    • 1
  1. 1.Department of Physiology and Cellular BiophysicsColumbia UniversityNew YorkUSA
  2. 2.Department of Medicine, College of Physicians and SurgeonsColumbia UniversityNew YorkUSA

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