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[Blood coagulation shifts in patients with myocardial infarction treated with streptokinase]
Insights
Streptokinase treatment for acute myocardial infarction alters coagulation, decreasing fibrinogen and plasminogen. Intravenous administration caused more significant changes than intracoronary, with similar bleeding risks.
Area of Science:
- Cardiology
- Hematology
- Pharmacology
Background:
- Acute myocardial infarction (AMI) treatment often involves thrombolytic therapy.
- Understanding coagulation parameter changes during AMI treatment is crucial for patient management.
- Streptokinase and heparin are commonly used anticoagulants.
Purpose of the Study:
- To assess variations in major coagulation parameters in AMI patients treated with streptokinase and/or heparin.
- To compare the effects of intravenous versus intracoronary streptokinase administration on coagulation.
- To investigate the relationship between coagulation shifts, coronary flow restoration, and hemorrhagic complications.
Main Methods:
- Analysis of coagulation parameters in 87 AMI patients.
- Treatment included streptokinase (intravenous or intracoronary) and/or heparin.
- Angiographic control was used to assess coronary flow.
- Monitoring of fibrinogen, plasminogen, alpha 2-antiplasmin, and fibrin/fibrinogen degradation products.
Main Results:
- Streptokinase treatment reduced plasma fibrinogen, plasminogen, and alpha 2-antiplasmin, increasing fibrin/fibrinogen degradation products.
- Intravenous streptokinase (1,000,000 units) induced greater coagulation shifts than intracoronary administration (120,000-180,000 units).
- Patients with restored coronary flow showed earlier declines and/or delayed normalization of fibrinogen, plasminogen, and alpha 2-antiplasmin compared to those with persistent occlusion.
- Hemorrhagic complication rates were similar across administration routes despite dose and coagulation shift differences.
Conclusions:
- Streptokinase therapy significantly impacts coagulation in AMI patients.
- Intravenous administration leads to more pronounced coagulation alterations than intracoronary.
- Coronary flow restoration is associated with distinct coagulation dynamics.
- The route of administration does not significantly affect hemorrhagic complication rates despite varying coagulation effects.
Abstract:
Variation in major coagulation parameters was assessed in 87 patients with acute myocardial infarction, treated with streptokinase and/or heparin under angiographic control. Streptokinase treatment was associated with a drop in plasma fibrinogen, plasminogen and alpha 2-antiplasmin, and an increase in serum fibrin/fibrinogen degradation products. The magnitude of coagulation shifts was greater in case of intravenous streptokinase infusion (1,000,000 units over 60 min), as compared to intracoronary streptokinase administration in lower doses (120,000-180,000 units over 60-90 min). In all patients with regained coronary flow, fibrinogen, plasminogen and alpha 2-antiplasmin levels began to decline significantly earlier and/or became normal significantly later, as compared to patients with persisting coronary occlusion. The rates and severity of hemorrhagic complications were basically similar in intravenous and intracoronary routes of administration, in spite of different doses and magnitude of coagulation shifts.