Circulation, Vol 83, 937-944, Copyright © 1991 by American Heart Association
DC Gulba, M Barthels, M Westhoff-Bleck, S Jost, W Rafflenbeul, WG Daniel, H Hecker and PR Lichtlen
BACKGROUND. It has been suggested that thrombolysis in a feedback reaction
may generate pro-coagulant activities. METHODS AND RESULTS. 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 micrograms/l (p
less than 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
micrograms/l in patients with persistent patency, they increased +7.5 +/-
13.6 micrograms/l in case of nonsuccessful thrombolysis (p less than 0.02)
and +11.9 +/- 23.8 micrograms/l in case of early reocclusion (p less than
0.001). For patients with thrombin-antithrombin III complex levels greater
than 6 ng/l 120 minutes into thrombolysis, the unfavorable clinical course
was predicted with 96.2% sensitivity and 93.1% specificity. CONCLUSION.
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.
ARTICLES
Increased thrombin levels during thrombolytic therapy in acute myocardial infarction. Relevance for the success of therapy
Division of Cardiology, Hannover Medical School, FRG.
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