Skip to main content
SpringerLink
Log in

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

  • Chapter
Fibrinogen, Thrombosis, Coagulation, and Fibrinolysis

Part of the book series: Advances in Experimental Medicine and Biology ((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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  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).

    Article  PubMed  CAS  Google Scholar 

  2. E. Braunwald, The path to myocardial salvage by thrombolytic therapy. Circulation, 76 (Suppl II):II2 (1987).

    PubMed  CAS  Google Scholar 

  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. 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. The ISAM Study Group. A prospective trial of intravenous streptokinase in acute myocardial infarction (ISAM). N. Engl. J. Med.,314:1465 (1986).

    Article  Google Scholar 

  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. M. Verstraete. The search for the ideal thrombolytic agent. J. Am. Coll. Cardiol., 10:4B (1987).

    Article  PubMed  CAS  Google Scholar 

  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. K. M. Jan, S. Chien, and J. T. Bigger Jr. Observation on blood viscosity changes after acute myocardial infarction. Circulation, 51:1079 (1975).

    Article  PubMed  CAS  Google Scholar 

  10. J. Dormandy, M. Boyd, and E. Ernst. Red cell filterability after myocardial infarction. Scand. J. Clin. Lab. Invest., 156:195 (1981).

    Article  CAS  Google Scholar 

  11. W. Bell. Objectives of thrombolytic therapy in acute myocardial infarction. Am. J. Med., 83(Suppl 2A):11 (1987).

    Article  PubMed  CAS  Google Scholar 

  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).

    Article  PubMed  CAS  Google Scholar 

  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).

    Article  PubMed  CAS  Google Scholar 

  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).

    Article  PubMed  CAS  Google Scholar 

  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).

    PubMed  CAS  Google Scholar 

  16. B. S. Neuhausen, and D. M. Rioch. The refractometric determination of serum protein. J. Biol. Chem., 55:353 (1923).

    CAS  Google Scholar 

  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).

    PubMed  CAS  Google Scholar 

  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).

    PubMed  CAS  Google Scholar 

  19. S. Chien, and K. M. Jan. Ultrastructural basis of the mechanism of rouleaux formation. Microvasc. Res.,5:155 (1973).

    Article  PubMed  CAS  Google Scholar 

  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).

    PubMed  CAS  Google Scholar 

  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).

    PubMed  CAS  Google Scholar 

  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. A. D. McLachlin, J. A. McLachlin, T. A. Jory, and E. C. Rawling. Venous stasis in the lower extremities. Ann. Surg., 152:678 (1960).

    Article  PubMed  CAS  Google Scholar 

  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. 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).

    Article  PubMed  CAS  Google Scholar 

  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).

    Article  Google Scholar 

  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. 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).

    Article  PubMed  CAS  Google Scholar 

  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).

    PubMed  CAS  Google Scholar 

  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).

    Article  PubMed  CAS  Google Scholar 

  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).

    Article  PubMed  CAS  Google Scholar 

  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. 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).

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Physiology and Cellular Biophysics, Columbia University, New York, NY, 10032, USA

    Kung-ming Jan, Walter Reinhart & Shu Chien

  2. Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA

    Eric Powers, Andrew Berke, Allen Nichols, Rita Watson, Dennis Reison & Allan Schwartz

Authors
  1. Kung-ming Jan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eric Powers
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Walter Reinhart
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andrew Berke
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Allen Nichols
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rita Watson
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dennis Reison
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Allan Schwartz
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shu Chien
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan, Republic of China

    Chung Yuan Liu

  2. University of California, San Diego, La Jolla, California, USA

    Shu Chien

Rights and permissions

Reprints and permissions

Copyright information

© 1990 Springer Science+Business Media New York

About this chapter

Cite this chapter

Jan, Km. et al. (1990). Altered Rheological Properties of Blood following Administrations of Tissue Plasminogen Activator and Streptokinase in Patients with Acute Myocardial Infarction. In: Liu, C.Y., Chien, S. (eds) Fibrinogen, Thrombosis, Coagulation, and Fibrinolysis. Advances in Experimental Medicine and Biology, vol 281. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-3806-6_44

Download citation

  • DOI: https://doi.org/10.1007/978-1-4615-3806-6_44

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4613-6697-3

  • Online ISBN: 978-1-4615-3806-6

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation