Document Detail


Augmented platelet aggregation as predictor of reocclusion after thrombolysis in acute myocardial infarction.
MedLine Citation:
PMID:  9869154     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
RATIONALE: Reocclusion after thrombolysis diminishes the benefits of early reperfusion after acute myocardial infarction (AMI). No clinical or laboratory variables have been identified as predictors for reocclusion yet. METHODS AND RESULTS: To evaluate hemostatic variables as potential risk determinants platelet aggregation (PA, representing platelet activity), thrombin/antithrombin complexes (TAT, representing thrombin generation), and plasminogen activator inhibitor type 1 (PAI-1, representing endogenous fibrinolysis) were determined in 31 patients with AMI at 0, 1, 2. and 12 h after the start of thrombolysis as well as at hospital discharge. Reocclusion (defined as reinfarction or angiographically confirmed, clinically silent coronary reocclusion) occurred in 5 patients within 5-14 days and in 8 patients within 1 year. TAT plasma concentrations were lower in patients with reocclusion than in those without (9.9+/-5.7 vs. 22.9+/-22.2 ng/ml at 2 h, 6.5+/-3.1 vs. 1 1.2+/-6.4 ng/ml at 12 h, means+/-SD, p <0.05 each). Neither concentration nor activity of PAI-1 in plasma differed between both patient groups. However, both slope and maximum of PA (induced by 2 micromol/l ADP) were augmented in patients with reocclusion (slope: 39.4+/-1.7 vs. 32.5+/-7.4 at 2 h, p <0.001; 42.6+/-2.6 vs. 36.6+/-8.9 at 12 h, p <0.01). Results were independent of the thrombolytic agent used (alteplase or reteplase). A PA slope at 2 h higher than the average slope before thrombolysis (37.2+/-5.7) could be identified as best predictor for early (within 5-14 d, p=0.017, sensitivity 1.00, specificity 0.69) and late reocclusion (within 1 y, p=0.009, 0.88 and 0.74, respectively). CONCLUSIONS: Increased PA following coronary thrombolysis appears to be associated with early and late reocclusion. This marker could be useful in identifying patients who may benefit from more aggressive antiplatelet (such as GP IIb/IIIa receptor antagonists), interventional, or both strategies.
Authors:
T K Nordt; M Moser; B Kohler; J Ruef; K Peter; W Kübler; C Bode
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Thrombosis and haemostasis     Volume:  80     ISSN:  0340-6245     ISO Abbreviation:  Thromb. Haemost.     Publication Date:  1998 Dec 
Date Detail:
Created Date:  1999-04-15     Completed Date:  1999-04-15     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7608063     Medline TA:  Thromb Haemost     Country:  GERMANY    
Other Details:
Languages:  eng     Pagination:  881-6     Citation Subset:  IM    
Affiliation:
Abteilung Kardiologie, Medizinische Klinik und Poliklinik, Ruprecht-Karls-Universität Heidelberg, Germany.
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MeSH Terms
Descriptor/Qualifier:
Adenosine Diphosphate / pharmacology
Adult
Aged
Aged, 80 and over
Anticoagulants / administration & dosage,  therapeutic use
Antithrombin III / analysis
Aspirin / administration & dosage,  therapeutic use
Coronary Vessels / pathology
Diabetes Mellitus / epidemiology
Drug Therapy, Combination
Female
Fibrinolysis
Heparin / administration & dosage,  therapeutic use
Humans
Male
Middle Aged
Myocardial Infarction / blood*,  drug therapy,  epidemiology
Obesity / epidemiology
Peptide Fragments
Peptide Hydrolases / analysis
Plasminogen Activator Inhibitor 1 / analysis
Plasminogen Activators / therapeutic use*
Platelet Aggregation* / drug effects
Predictive Value of Tests
Prothrombin
Recombinant Proteins / therapeutic use
Recurrence
Risk Factors
Smoking / epidemiology
Thrombolytic Therapy*
Tissue Plasminogen Activator / therapeutic use*
Vascular Patency
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Peptide Fragments; 0/Plasminogen Activator Inhibitor 1; 0/Recombinant Proteins; 0/antithrombin III-protease complex; 0/prothrombin fragment 1.2; 133652-38-7/reteplase; 50-78-2/Aspirin; 58-64-0/Adenosine Diphosphate; 9000-94-6/Antithrombin III; 9001-26-7/Prothrombin; 9005-49-6/Heparin; EC 3.4.-/Peptide Hydrolases; EC 3.4.21.-/Plasminogen Activators; EC 3.4.21.68/Tissue Plasminogen Activator

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