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Alterations in the fibrinolytic system components during acute myocardial infarction
E Ioannidou-Papayannaki1, N Lefkos, G Boudonas
1Haematology Laboratory of 2nd Dept. of Internal Medicine, Aristotelian University of Thessaloniki, Hippokration Hospital, Greece.
Insights
This study investigated changes in tissue-plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1), and D-dimer (DD) in acute myocardial infarction patients post-thrombolytic therapy. Elevated t-PA, PAI-1, and DD levels correlated with infarct size, aiding treatment assessment.
Area of Science:
- Cardiology
- Biochemistry
- Thrombolysis
Background:
- Acute myocardial infarction (AMI) involves blood clot formation.
- Thrombolytic therapy aims to dissolve these clots.
- Biomarkers like t-PA, PAI-1, and D-dimer reflect coagulation and fibrinolysis states.
Purpose of the Study:
- To assess changes in plasma t-PA, PAI-1, and D-dimer levels in AMI patients after thrombolytic therapy.
- To compare these changes between rt-PA and acetyl-streptokinase treatments.
- To explore correlations between these markers and infarct size estimated by peak serum CPK levels.
Main Methods:
- Enzyme immunoassay (Stago) was used to measure plasma levels of t-PA, PAI-1, and D-dimer.
- 57 AMI patients and 25 healthy controls were included.
- Plasma samples were collected at baseline, 4 hours, and 24 hours post-therapy.
Main Results:
- AMI patients exhibited higher baseline t-PA, PAI-1, and D-dimer levels compared to controls.
- Thrombolytic therapy led to significant increases in t-PA, PAI-1, and D-dimer at 4 hours.
- While t-PA and D-dimer remained elevated at 24 hours, PAI-1 returned to baseline levels. No significant differences were observed between rt-PA and acetyl-streptokinase treatments.
- t-PA and PAI-1 levels positively correlated with infarct size.
Conclusions:
- Thrombolytic therapy significantly alters coagulation and fibrinolysis markers in AMI patients.
- These marker changes are related to infarct size, potentially aiding in treatment monitoring.
- Both rt-PA and acetyl-streptokinase demonstrated similar effects on these biomarkers.
Abstract:
The purpose of this study was to evaluate the changes in tissue-plasminogen activator (t-PA), plasminogen activator inhibitor - type 1 (PAI-1) and D-dimer (DD) antigen plasma levels in acute myocardial infarction (AMI) patients after thrombolytic therapy with two different thrombolytic agents, rt-PA or acetyl-streptokinase and to find out any correlation between the plasma t-PA, PAI-1 and DD levels with the infarct size as it is estimated from the peak of serum CPK levels. The plasma antigen levels of t-PA, PAI-1 and DD were measured by the enzyme immunoassay method (Stago), in 57 consecutive patients (M = 46, F = 11, mean age 55.6 +/- 8.8 years) and in 25 normal subjects (M = 18, F = 7, mean age 54.0 +/- 5.5 years). In 47 out of the 57 patients who were treated successfully with 100 mg of rt-PA (26 patients) or with 1.5 MU 21 of acetyl-streptokinase, as well as in 10 patients who were not treated, samples were obtained again 4 and 24 hours after the end of thrombolytic therapy or admission, respectively. During the acute phase of myocardial infarction the t-PA, PAI-1 and DD antigen plasma levels were significantly higher than in healthy people. There were no significant changes in the t-PA, PAI-1 and DD plasma levels of the patients who were not treated with a thrombolytic agent. We found a significant elevation of t-PA (p < 0.001), PAI-1 (p < 0.05) and DD (p < 0.001) after 4 hours in comparison with the baseline (at presentation, before therapy). After 24 hours the t-PA and DD plasma levels remained significantly higher (p < 0.001) while the PAI-1 plasma levels returned to the pre-therapy levels. There were no significantly different changes in the t-PA, PAI-1 and DD plasma levels of either group of patients, treated with rt-PA or acetyl-streptokinase while the t-PA and PAI-1 levels were positively correlated with infarct size as estimated from peak serum CPK levels.