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Effects of gemfibrozil on lipids and haemostasis after myocardial infarction
P Andersen1, P Smith, I Seljeflot
1Dept. of Medicine, Red Cross Clinic, Oslo, Norway.
Insights
Gemfibrozil significantly reduced triglycerides and improved fibrinolytic capacity in myocardial infarction survivors. It also lowered clotting factor VII-phospholipid complex, suggesting a reduced hypercoagulability risk.
Area of Science:
- Cardiology
- Pharmacology
- Hematology
Background:
- Myocardial infarction (MI) survivors often have dyslipidemia, specifically elevated triglycerides (TG).
- Impaired fibrinolytic capacity and hypercoagulability are common post-MI, increasing thrombotic risk.
Purpose of the Study:
- To investigate the effects of gemfibrozil on hemostatic variables in MI survivors with hypertriglyceridemia.
- To assess gemfibrozil's impact on fibrinolysis and coagulation factors.
Main Methods:
- Double-blind, placebo-controlled study in 43 MI survivors with TG ≥ 2 mmol/l.
- Participants received gemfibrozil (600 mg twice daily) or placebo for 8 weeks.
- Assessed serum TG, fibrinogen, bleeding time, platelet count, clotting factor VII-phospholipid complex, and DDAVP-stimulated D-Dimer.
Main Results:
- Gemfibrozil significantly reduced TG by 44% (p < 0.001); placebo showed no change.
- Clotting factor VII-phospholipid complex decreased by 60% in the gemfibrozil group (p < 0.01).
- Gemfibrozil eliminated reduced fibrinolytic capacity observed in 38% of the placebo group (p = 0.001).
Conclusions:
- Gemfibrozil effectively lowers triglycerides in MI survivors.
- Gemfibrozil improves fibrinolytic capacity and may reduce hypercoagulability by decreasing clotting factor VII-phospholipid complex.
Abstract:
The effects of gemfibrozil on haemostatic variables were studied in 43 survivors of myocardial infarction with serum triglycerides (TG) greater than or equal to 2 mmol/l 2 weeks prior to randomization. The study was double-blind, placebo-controlled and stratified for chronic betablockade. Twenty-two individuals were given gemfibrozil 600 mg twice daily and 21 individuals received matching placebo. After 8 weeks the TG level was unchanged in the placebo group, whereas a 44% reduction was noted in the gemfibrozil group (p less than 0.001). Fibrinogen increased in both groups, while bleeding time and platelet count were unchanged. Clotting factor VII-phospholipid complex decreased in both groups, but the change was more marked and attained statistical significance only in the gemfibrozil group (60% reduction, p less than 0.01). By DDAVP-stimulated D-Dimer agglutination test 8 in 21 patients in the placebo group (38%) still had reduced fibronolytic capacity versus none in the gemfibrozil group (p = 0.001). Thus, in this study, gemfibrozil improved reduced fibrinolytic capacity and may have reduced hypercoagulability by lowering the clotting factor VII-phospholipid complex.