Document Detail


Microparticle-linked tissue factor activity and increased thrombin activity play a potential role in fibrinolysis failure in ST-segment elevation myocardial infarction.
MedLine Citation:
PMID:  19350119     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Fibrinolysis for acute ST-segment elevation MI achieves early recanalisation of the infarct artery in approximately 60% of cases. The aim of the study was to determine whether failure to achieve recanalisation was associated with differences in haemostasis biomarkers compared to patients with successful fibrinolysis. Fourty-three patients were prospectively enrolled in a case-control study. All patients had received tenecteplase (TNK-tPA) together with aspirin (500 mg) and heparin (5,000 IU). Emergency angiography within 90 minutes of bolus TNK-tPA identified 13 TIMI 0-2 patients (cases) and 30 TIMI 3 patients (controls). Blood samples were collected before angiography to determine tissue factor activity associated with microparticles (TF-MP); soluble platelet glycoprotein V (sGPV) and thrombin-antithrombin complexes (TAT) as markers of thrombin generation; tissue plasminogen activator (endogenous tPA+ TNK-tPA), plasminogen activator inhibitor (PAI-1) and plasmin-antiplasmin complexes (PAP) as markers of plasmin generation. The baseline characteristics of the two patients' groups were similar with respect to sex, age, and risks factors. Cases differed from controls by higher TF-MP levels (1.9 [1-13] vs. 1 [0.6-1.3] pM), sGPV (67 [51-126] vs. (48 [39-72] ng/ml), p = 0.039 and TAT (10 [4-37.5] vs. 4 [2.9-7.2] ng/ml), p = 0.035. TAT correlated with TF-MP (r = 0.51, p = 0.0064) and sGPV (r = 0.51, p = 0.0018). No significant difference was observed in tPA or PAI-1 levels. PAP were lower in cases (18.83 [14.83-40.43] mug/ml) than in controls (35.83 [27.9-43.94] mug/ml), p = 0.045. In conclusion, fibrinolysis failure in AMI is characterised by a higher procoagulant state associated with TF-MP and a lower plasmin generation.
Authors:
Marie-Geneviève Huisse; Nadine Ajzenberg; Laurent Feldman; Marie-Claude Guillin; Philippe Gabriel Steg
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Thrombosis and haemostasis     Volume:  101     ISSN:  0340-6245     ISO Abbreviation:  Thromb. Haemost.     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-04-07     Completed Date:  2009-10-30     Revised Date:  2009-11-19    
Medline Journal Info:
Nlm Unique ID:  7608063     Medline TA:  Thromb Haemost     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  734-40     Citation Subset:  IM    
Affiliation:
Department of Haematology, AP-HP, Hôpital Bichat, Paris, France. marie-genevieve.huisse@bch.aphp.fr
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Angioplasty, Transluminal, Percutaneous Coronary
Anticoagulants / administration & dosage
Aspirin / administration & dosage
Biological Markers / blood
Case-Control Studies
Cell-Derived Microparticles / drug effects*,  metabolism
Coronary Angiography
Coronary Circulation
Drug Administration Schedule
Drug Therapy, Combination
Emergency Treatment
Female
Fibrinolysin / metabolism
Fibrinolytic Agents / administration & dosage*
Hemostasis / drug effects*
Heparin / administration & dosage
Humans
Male
Middle Aged
Myocardial Infarction / blood,  drug therapy*,  physiopathology,  radiography
Platelet Aggregation Inhibitors / administration & dosage
Prospective Studies
Thrombin / metabolism*
Thrombolytic Therapy*
Thromboplastin / metabolism*
Time Factors
Tissue Plasminogen Activator / administration & dosage*
Treatment Failure
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Biological Markers; 0/Fibrinolytic Agents; 0/Platelet Aggregation Inhibitors; 50-78-2/Aspirin; 9005-49-6/Heparin; 9035-58-9/Thromboplastin; EC 3.4.21.-/TNK-tissue plasminogen activator; EC 3.4.21.5/Thrombin; EC 3.4.21.68/Tissue Plasminogen Activator; EC 3.4.21.7/Fibrinolysin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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