Circulation, Vol 90, 61-68, Copyright © 1994 by American Heart Association
PA Merlini, KA Bauer, L Oltrona, D Ardissino, M Cattaneo, C Belli, PM Mannucci and RD Rosenberg
BACKGROUND: The blood coagulation system is activated in the acute phase of
unstable angina and acute myocardial infarction. However, it remains
unclear whether augmented function of the hemostatic mechanism serves only
as a marker of the acute thrombotic episode or whether a hypercoagulable
state persists for a prolonged period after clinical stabilization. METHODS
AND RESULTS: We prospectively measured the plasma concentrations of
prothrombin fragment 1 + 2 (F1 + 2) and fibrinopeptide A (FPA) in
consecutive patients presenting with unstable angina (n = 81) or acute
myocardial infarction (n = 32), respectively. At 6 months, plasma
determinations were repeated in patients experiencing an uneventful
clinical course (unstable angina, n = 57; myocardial infarction, n = 23).
We quantitated the plasma levels of F1 + 2 and FPA in control patients with
stable angina (n = 37) or healthy individuals (n = 32) who were matched for
age and sex. The median plasma concentrations of F1 + 2 and FPA are
significantly higher in patients presenting with unstable angina (F1 + 2,
1.08 nmol/L; FPA, 2.4 nmol/L) or acute myocardial infarction (F1 + 2, 1.27
nmol/L; FPA, 3.55 nmol/L) compared with patients with stable angina (F1 +
2, 0.74 nmol/L; FPA, 1.3 nmol/L; P < .0001) or healthy individuals (F1 +
2, 0.71 nmol/L; FPA, 0.80 nmol/L; P < .0001). At 6 months, the median
plasma levels of F1 + 2 in patients exhibiting an uneventful clinical
course did not differ from values obtained at admission (unstable angina,
1.26 versus 1.07 nmol/L, P = NS; myocardial infarction, 1.22 versus 1.29
nmol/L, P = NS), whereas the median plasma levels of FPA in the same two
subpopulations were significantly reduced (unstable angina, 1.1 versus 2.9
nmol/L, P = .0003; myocardial infarction, 1.1 versus 3.0 nmol/L; P =
.0028). CONCLUSIONS: During the acute phase of unstable angina and
myocardial infarction, patients exhibit increased coagulation system
activity. Over the next 6 months, patients with unstable angina or
myocardial infarction experiencing an uneventful clinical course manifest a
persistent hypercoagulable state with minimal generation of fibrin.
ARTICLES
Persistent activation of coagulation mechanism in unstable angina and myocardial infarction
2nd Division of Cardiology, Ca'Granda Niguarda Hospital, Milan, Italy.
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