Thrombin generation and fibrinolytic activities among patients receiving reduced-dose alteplase plus abciximab or undergoing direct angioplasty plus abciximab for acute myocardial infarction

• Published in: The American journal of cardiology 2002-04, Vol.89 (8), p.930-936
• Main Authors: Mak, Koon-Hou, Lee, Lai-Heng, Wong, Aaron, Chan, Charles, Koh, Tian-Hai, Lau, Kean-Wah, Lim, Yean-Leng
• Format: Article
• Language: English
• Subjects: Abciximab; Angioplasty; Angioplasty, Balloon, Coronary; Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal - therapeutic use; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Cardiology; Clinical trials; Combined Modality Therapy; Drug Therapy, Combination; Female; Fibrinolysis; Fibrinolytic Agents - administration & dosage; Fibrinolytic Agents - therapeutic use; Humans; Immunoglobulin Fab Fragments - administration & dosage; Immunoglobulin Fab Fragments - therapeutic use; Male; Medical sciences; Middle Aged; Myocardial Infarction - blood; Myocardial Infarction - therapy; Pharmacology. Drug treatments; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - therapeutic use; Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors; Thrombin - biosynthesis; Tissue Plasminogen Activator - administration & dosage; Tissue Plasminogen Activator - therapeutic use
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(02)02241-5

The purpose of this study was to determine the impact of these 2 reperfusion strategies (reduced-dose alteplase plus abciximab or direct angioplasty plus abciximab) on fibrinolytic and thrombin generation activities. The effect of reduced-dose alteplase plus abciximab and direct angioplasty plus abciximab on hemostatic factors is unknown. Of 70 patients with acute myocardial infarction of ≤6 hours, 34 were randomized to reduced-dose alteplase (35 to 50 mg in 1 hour) and 36 to direct angioplasty. A standard bolus and infusion dose of abciximab was administered to all patients. Blood specimens were collected at baseline, and at 1, 4, 12, and 24 hours. The following parameters were assayed: fibrinogen, plasminogen and antiplasmin activities, tissue plasminogen activator antigen, d-dimer, prothrombin fragments F1 + 2, and thrombin/antithrombin III complexes. Among patients treated with reduced-dose alteplase plus abciximab, the fibrinogen level decreased by 28.4% in the first hour (11.7 ± 3.4 vs 7.8 ± 2.5 μmol/L, p