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Increased thrombin levels during thrombolytic therapy in acute myocardial infarction. Relevance for the success of therapy

, : Increased thrombin levels during thrombolytic therapy in acute myocardial infarction. Relevance for the success of therapy. Circulation 83(3): 937-944

It has been suggested that thrombolysis in a feedback reaction may generate pro-coagulant activities. Fifty-five patients were treated with urokinase-preactivated prourokinase (n = 35) or tissue-type plasminogen activator (n = 20) for acute myocardial infarction and underwent coronary angiography at 90 minutes and at 24-36 hours into thrombolysis, and fibrinogen (Ratnoff-Menzie), D-dimer (ELISA) and thrombin-antithrombin III complex levels (ELISA) were measured. Primary patency was achieved in 39 patients (70.9%), 13 of whom (33.3%) suffered early reocclusion. Nonsignificant decreases in fibrinogen levels were observed while D-dimer levels increased +3,008 .+-. 4,047 .mu.g/l (p < 0.01), differences not being significant in respect to the thrombolytic agents or to the clinical course. In contrast, while thrombin-antithrombin III complex levels decreased -4.4 .+-. 13.0 .mu.g/l in patients with persistent patency, they increased +7.5 .+-. 13.6 .mu.g/l in case of nonsuccessful thrombolysis (p < 0.02) and +11.9 .+-. 23.8 .mu.g/l in case of early reocclusion (p < 0.001). For patients with thrombin-antithrombin III complex level greater than 6 ng/l 120 minutes into thrombolysis, the unfavorable clinical course was predicted with 96.2% sensitivity and 93.1% specificity. Generation of thrombin, occurring during thrombolysis, is a major determinant for the success of therapy and thrombin-antithrombin III levels may serve as predictors for the short-term prognosis.


PMID: 1900225

DOI: 10.1161/01.cir.83.3.937

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