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Relationship between intracoronary thrombolysis and fibrino-coagulation--special reference to TAT/PIC and FPA/PIC
H Uenomachi1, M Sonoda, T Miyauchi
12nd Department of Internal Medicine, School of Medicine, Kagoshima University, Japan.
Insights
In acute myocardial infarction (AMI) patients, hypercoagulation is evident. The thrombin-antithrombin III complex/plasmin-alpha 2-plasmin inhibitor complex (TAT/PIC) ratio before therapy may predict successful intracoronary thrombolytic therapy (ICT) outcomes.
Area of Science:
- Cardiology
- Hematology
- Biochemistry
Background:
- Acute myocardial infarction (AMI) involves complex interactions between coagulation and fibrinolysis.
- Intracoronary thrombolytic therapy (ICT) aims to restore blood flow but its success can be influenced by the patient's hemostatic status.
Purpose of the Study:
- To investigate the relationship between coagulation/fibrinolysis markers and the efficacy of ICT in AMI patients.
- To identify predictive markers for successful ICT outcomes.
Main Methods:
- Measured thrombin-antithrombin III complex (TAT), fibrinopeptide A (FPA), and plasmin-alpha 2-plasmin inhibitor complex (PIC) in AMI patients undergoing ICT.
- Compared marker levels between successful (group S) and unsuccessful (group F) ICT groups, and a control group (group C).
- Analyzed the ratio of TAT/PIC and FPA/PIC as indicators of the fibrino-coagulating system's equilibrium.
Main Results:
- AMI patients exhibited significantly higher TAT and FPA levels compared to controls, indicating hypercoagulation.
- While TAT and FPA levels were not significantly different between successful and unsuccessful ICT groups, the TAT/PIC ratio was significantly higher in the unsuccessful group (group F) before therapy.
- The TAT/PIC ratio, but not FPA/PIC, differentiated between successful and unsuccessful ICT outcomes.
Conclusions:
- Hypercoagulation is a feature of AMI.
- The TAT/PIC ratio before ICT may serve as a valuable index for predicting the success of thrombolytic therapy in AMI patients.
- This ratio might reflect the equilibrium of the fibrino-coagulating system, offering insights beyond individual marker measurements.
Abstract:
To clarify the relationship between the results of intracoronary thrombolytic therapy (ICT) and fibrino-coagulation in patients with acute myocardial infarction (AMI), the thrombin-antithrombin III complex (TAT) and fibrinopeptide A (FPA), as indices of accelerated coagulation, and the plasmin- alpha 2-plasmin inhibitor complex (PIC), as an index of accelerated fibrinolysis in peripheral blood, were measured just before and after heparin injection (5,000 U), and immediately after ICT. Twenty-four patients with AMI were divided into 2 groups according to the results of ICT; successful ICT (group S) and unsuccessful ICT (group F). As a control group (group C), 14 age-matched normal volunteers were also studied. The levels of TAT and FPA before ICT were significantly higher in groups S and F than in group C (p < 0.01). The TAT level before ICT in group F was higher than that in group S (p = 0.07), however, the TAT, FPA and PIC levels showed no significant differences between groups S and F at each sampling time. TAT/PIC before ICT was significantly higher in group F than in group S (F: 0.026 +/- 0.020 vs S: 0.008 +/- 0.004, p < 0.05), whereas there was no remarkable difference in FPA/PIC between groups S and F. These results indicate that hyper-coagulation had occurred in the AMI cases and that coagulation had been more accelerated in group F. TAT/PIC might be an index of the equilibrium of the fibrino-coagulating system. Therefore, TAT/PIC measurement before thrombolytic therapy may be more useful than TAT measurement alone for evaluating recanalization in ICT.