Author + information
- Received July 23, 1985
- Revision received October 22, 1985
- Accepted January 13, 1986
- Published online June 1, 1986.
- Paul R. Eisenberg, MD,
- Laurence Sherman, MD,
- Michael Rich, MD,
- David Schwartz, MD,
- Kenneth Schechtman, PHD,
- Edward M. Geltman, MD, FACC,
- Burton E. Sobel, MD, FACC and
- Allan S. Jaffe, MD, FACCa
- ↵aAddress for reprints: Allan S. Jaffe, MD, Washington University School of Medicine, Cardiovascular Division, Box 8086, 660 South Euclid Avenue, St. Louis, Missouri 63110.
Factors responsible for initial success or failure of coronary thrombolysis and persistent recanalization or early reocclusion have not been thoroughly elucidated. Both adequate initial clot lysis and preclusion of rethrombosis are required. Failure may reflect clot lysis followed immediately or somewhat later by rethrombosis. To determine whether differences in the intensity and persistence of the activation of thrombin are determinants of success or failure of recanalization, plasma fibrinopeptide A, a fibrinogen product liberated by thrombin, was serially assayed in 19 patients treated with intravenous streptokinase. In patients exhibiting recanalization (n = 9), plasma fibrinopeptide A decreased after administration of streptokinase but before administration of heparin. In patients without initially apparent recanalization, fibrinopeptide A increased, suggesting ongoing thrombosis, and subsequently decreased promptly after heparin. In patients with initial recanalization followed by overt reocclusion the pattern was different. Despite recanalization, fibrinopeptide A continued to rise markedly. Elevations persisted despite administration of heparin. Thus, inhibition of activation of thrombin is associated with successful recanalization. Conversely, persistent activation of thrombin may be a predisposing factor to both apparent initial failure of recanalization and nvprt early reocclusion.
This study was supported in part by Specialized Center of Research in Ischemic Heart Disease, National Institutes of Health Grant HL 17646, Bethesda, Maryland and a grant from The American National Red Cross, St. Louis, Missouri.
- Received July 23, 1985.
- Revision received October 22, 1985.
- Accepted January 13, 1986.
- American College of Cardiology Foundation