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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 W. T. Hermens, M. M. A. L. Pelsers, M.-L. Mullers-Boumans, C. de Zwaan, and J. F. C. Glatz Combined Use of Markers of Muscle Necrosis and Fibrinogen Conversion in the Early Differentiation of Myocardial Infarction and Unstable Angina Clin. Chem., April 1, 1998; 44(4): 890 - 892. [Full Text] [PDF]
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D. A. Vorchheimer and V. Fuster Oral Platelet Glycoprotein IIb/IIIa Receptor Antagonists: The Present Challenge Is Safety Circulation, February 3, 1998; 97(4): 312 - 314. [Full Text] [PDF]
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G. Ghigliotti, A. R. Waissbluth, C. Speidel, D. R. Abendschein, and P. R. Eisenberg Prolonged Activation of Prothrombin on the Vascular Wall After Arterial Injury Arterioscler Thromb Vasc Biol, February 1, 1998; 18(2): 250 - 257. [Abstract] [Full Text] [PDF]
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F. Bernardi, P. Arcieri, R. M. Bertina, F. Chiarotti, J. Corral, M. Pinotti, H. Prydz, M. Samama, P. M. Sandset, R. Strom, et al. Contribution of Factor VII Genotype to Activated FVII Levels : Differences in Genotype Frequencies Between Northern and Southern European Populations Arterioscler Thromb Vasc Biol, November 1, 1997; 17(11): 2548 - 2553. [Abstract] [Full Text]
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M. Frohlich, M. Sund, S. Russ, A. Hoffmeister, H. G. Fischer, V. Hombach, and W. Koenig Seasonal Variations of Rheological and Hemostatic Parameters and Acute-Phase Reactants in Young, Healthy Subjects Arterioscler Thromb Vasc Biol, November 1, 1997; 17(11): 2692 - 2697. [Abstract] [Full Text]
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F.-C. Schoebel, F. Gradaus, K. Ivens, P. Heering, T. W. Jax, B. Grabensee, B.-E. Strauer, and M. Leschke Restenosis after elective coronary balloon angioplasty in patients with end stage renal disease: a case-control study using quantitative coronary angiography Heart, October 1, 1997; 78(4): 337 - 342. [Abstract] [Full Text] [PDF]
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P. A. Merlini, D. Ardissino, K. A. Bauer, L. Oltrona, A. Pezzano, B. Bottasso, R. D. Rosenberg, and P. M. Mannucci Persistent Thrombin Generation During Heparin Therapy in Patients With Acute Coronary Syndromes Arterioscler Thromb Vasc Biol, July 1, 1997; 17(7): 1325 - 1330. [Abstract] [Full Text]
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W. Klein, A. Buchwald, S. E. Hillis, S. Monrad, G. Sanz, A. G. G. Turpie, J. van der Meer, E. Olaisson, S. Undeland, and K. Ludwig Comparison of Low-Molecular-Weight Heparin With Unfractionated Heparin Acutely and With Placebo for 6 Weeks in the Management of Unstable Coronary Artery Disease : Fragmin in Unstable Coronary Artery Disease Study (FRIC) Circulation, July 1, 1997; 96(1): 61 - 68. [Abstract] [Full Text]
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W. M. Feinberg, E. S. Cornell, S. D. Nightingale, L. A. Pearce, R. P. Tracy, R. G. Hart, and E. G. Bovill Relationship Between Prothrombin Activation Fragment F1.2 and International Normalized Ratio in Patients With Atrial Fibrillation Stroke, June 1, 1997; 28(6): 1101 - 1106. [Abstract] [Full Text]
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L. Oltrona, M. Broccolino, P. A. Merlini, A. Spinola, A. Pezzano, and P. M. Mannucci Activation of the Hemostatic Mechanism After Pharmacological Cardioversion of Acute Nonvalvular Atrial Fibrillation Circulation, April 15, 1997; 95(8): 2003 - 2006. [Abstract] [Full Text]
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H. Philippou, A. Adami, R. A. Amersey, P. J. Stubbs, and D. A. Lane A Novel Specific Immunoassay for Plasma Two-Chain Factor VIIa: Investigation of FVIIa Levels in Normal Individuals and in Patients With Acute Coronary Syndromes Blood, February 1, 1997; 89(3): 767 - 775. [Abstract] [Full Text] [PDF]
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A. K. Rao, L. Sun, J. H. Chesebro, V. Fuster, R. A. Harrington, D. Schwartz, P. Gallo, D. Matos, and E. J. Topol Distinct Effects of Recombinant Desulfatohirudin (Revasc) and Heparin on Plasma Levels of Fibrinopeptide A and Prothrombin Fragment F1.2 in Unstable Angina: A Multicenter Trial Circulation, November 15, 1996; 94(10): 2389 - 2395. [Abstract] [Full Text]
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L. Oltrona, P. R. Eisenberg, J. M. Lasala, D. J. Sewall, M. E. Shelton, and K. J. Winters Association of Heparin-Resistant Thrombin Activity With Acute Ischemic Complications of Coronary Interventions Circulation, November 1, 1996; 94(9): 2064 - 2071. [Abstract] [Full Text]
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C. R. McKenzie, D. R. Abendschein, and P. R. Eisenberg Sustained Inhibition of Whole-Blood Clot Procoagulant Activity by Inhibition of Thrombus-Associated Factor Xa Arterioscler Thromb Vasc Biol, October 1, 1996; 16(10): 1285 - 1291. [Abstract] [Full Text]
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J. D. Marmur, S. V. Thiruvikraman, B. S. Fyfe, A. Guha, S. K. Sharma, J. A. Ambrose, J. T. Fallon, Y. Nemerson, and M. B. Taubman Identification of Active Tissue Factor in Human Coronary Atheroma Circulation, September 15, 1996; 94(6): 1226 - 1232. [Abstract] [Full Text]
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J. A. Ambrose and M. Weinrauch Thrombosis in Ischemic Heart Disease Arch Intern Med, July 8, 1996; 156(13): 1382 - 1394. [Abstract] [PDF]
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L. M. Biasucci, G. Liuzzo, G. Caligiuri, G. Quaranta, F. Andreotti, G. Sperti, W. van de Greef, A. G. Rebuzzi, C. Kluft, and A. Maseri Temporal Relation Between Ischemic Episodes and Activation of the Coagulation System in Unstable Angina Circulation, June 15, 1996; 93(12): 2121 - 2127. [Abstract] [Full Text]
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D. Ardissino, P. A. Merlini, G. Gamba, P. Barberis, G. Demicheli, S. Testa, E. Colombi, A. Poli, R. Fetiveau, and C. Montemartini Thrombin Activity and Early Outcome in Unstable Angina Pectoris Circulation, May 1, 1996; 93(9): 1634 - 1639. [Abstract] [Full Text]
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P. A. Merlini, D. Ardissino, L. Oltrona, M. Broccolino, R. Coppola, and P. M. Mannucci Heightened Thrombin Formation but Normal Plasma Levels of Activated Factor VII in Patients With Acute Coronary Syndromes Arterioscler Thromb Vasc Biol, October 1, 1995; 15(10): 1675 - 1679. [Abstract] [Full Text]
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T. Murakami, Y. Komiyama, M. Masuda, M. Karakawa, T. Iwasaka, and H. Takahashi Evaluation of Factor XIa–{alpha}1-Antitrypsin in Plasma, a Contact Phase–Activated Coagulation Factor–Inhibitor Complex, in Patients With Coronary Artery Disease Arterioscler Thromb Vasc Biol, August 1, 1995; 15(8): 1107 - 1113. [Abstract] [Full Text]
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E. Falk, P. K. Shah, and V. Fuster Coronary Plaque Disruption Circulation, August 1, 1995; 92(3): 657 - 671. [Full Text]
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D. Pratico and G. A. FitzGerald Testosterone and Thromboxane : Of Muscles, Mice, and Men Circulation, June 1, 1995; 91(11): 2694 - 2698. [Full Text]
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P. A. Merlini, A. Repetto, A. Lombardi, A. Vetrano, R. Fetiveau, C. Cavallini, D. Sappe, A. Salvioni, R. Canziani, S. Savonitto, et al. Effect of Abciximab on Prothrombin Activation and Thrombin Generation in Acute Coronary Syndromes Without ST-Segment Elevation: Global Utilization of Strategies to Open Occluded Coronary Arteries Trial IV in Acute Coronary Syndromes (GUSTO IV ACS) Italian Hematologic Substudy Circulation, February 26, 2002; 105(8): 928 - 932. [Abstract] [Full Text] [PDF]
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