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Selective decrease in lysis of old thrombi after rapid administration of tissue-type plasminogen activator.

K Kanamasa1, I Watanabe, B Cercek

  • 1Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California 90048.

Journal of the American College of Cardiology
|November 1, 1989
PubMed
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This study shows that faster administration of recombinant tissue-type plasminogen activator (rt-PA) significantly improves the lysis of fresh coronary thrombi compared to older hemostatic thrombi. This suggests a potential for safer thrombolytic therapy in acute myocardial infarction.

Area of Science:

  • Cardiovascular Research
  • Thrombolytic Therapy
  • Biomedical Science

Background:

  • Acute myocardial infarction (AMI) safety can be enhanced by selectively dissolving coronary thrombi.
  • Older hemostatic thrombi outside the coronary arteries pose a challenge to current thrombolytic treatments.

Purpose of the Study:

  • To investigate if the lysis rate of fresh versus aged thrombi can be influenced by the speed of recombinant tissue-type plasminogen activator (rt-PA) administration.
  • To assess the potential for differential thrombolysis in the context of AMI treatment.

Main Methods:

  • 17 dogs were used to create 1-hour and 24-hour old thrombi in jugular and femoral veins using copper coils.
  • Thrombi were transferred to carotid and femoral arteries and treated with rt-PA (1 mg/kg) infused over 180 or 30 minutes.

Related Experiment Videos

  • Residual thrombus weight was measured after infusions to determine lysis rates.

    • Main Results:

    • Older (24-hour) thrombi showed significantly less lysis than fresh (1-hour) thrombi across all experimental groups (p < 0.001).
    • Faster rt-PA infusion (30 min) resulted in higher lysis of fresh thrombi (65.2% vs. 86.1% at 180 min infusion) compared to older thrombi (16.6% vs. 53.9%).
    • Even after a 30-minute infusion and a 45-minute observation period, fresh thrombi lysis was significantly higher (91.7%) than 24-hour thrombi lysis (21.6%).

    Conclusions:

    • The rate of rt-PA administration can influence the differential lysis of fresh versus older thrombi.
    • Rapid rt-PA infusion demonstrates potential for selectively targeting acute coronary thrombi while sparing older hemostatic ones.
    • This finding supports the development of improved thrombolytic strategies for acute myocardial infarction.