Relation of coagulation parameters to patency and recurrent ischemia in the Thrombolysis in Myocardial Infarction (TIMI) Phase II Trial

Current protocols for use of tissue-type plasminogen activator in acute myocardial infarction include heparin estimated by the activated partial thromboplastin time (aPTT). Recent reports indicate a risk of recurrent ischemic events with long aPTT values. Longer aPTT values in the Thrombolysis in My...

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Bibliographic Details
Published in:The American heart journal 1998, Vol.135 (1), p.29-37
Main Authors: Tracy, Russell P., Kleiman, Neal S., Thompson, Bruce, Cannon, Christopher P., Bovill, Edwin G., Brown, R.Greg, Collen, Desire, Mahan, Edward, Mann, Kenneth G., Rogers, William J., Sopko, George, Stump, David C., Williams, David O., Zaret, Barry L.
Format: Article
Language:English
Subjects:
Biological and medical sciences
Blood. Blood coagulation. Reticuloendothelial system
Fibrinogen - analysis
Humans
Medical sciences
Myocardial Infarction - blood
Myocardial Infarction - drug therapy
Myocardial Infarction - physiopathology
Partial Thromboplastin Time
Pharmacology. Drug treatments
Plasminogen - analysis
Recurrence
Thrombolytic Therapy
Tissue Plasminogen Activator - blood
Tissue Plasminogen Activator - therapeutic use
Vascular Patency
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Summary:Current protocols for use of tissue-type plasminogen activator in acute myocardial infarction include heparin estimated by the activated partial thromboplastin time (aPTT). Recent reports indicate a risk of recurrent ischemic events with long aPTT values. Longer aPTT values in the Thrombolysis in Myocardial Infarction-II (TIMI II) Trial, obtained within the first 48 hours, were associated with patency at 18 to 48 hours and better left ventricular function at discharge (average 9.6 days), but also with emergency catheterizations within the first 48 hours and, weakly, with recurrent ischemia during the first 18 hours. A moderate decrease in fibrinogen, compared with a “small” decrease, was also associated with patency, but a “large” decrease was associated with hemorrhagic events. Patency was associated with higher fibrinogen values and higher plasminogen values at baseline. The aPTT results support frequent monitoring during the first 24 to 48 hours to ensure optimal clinical outcome. The coagulation factor results suggest that there may be an optimum window for fibrinogenolysis in this setting. (Am Heart J 1998;135:29-37.)
ISSN:0002-8703
1097-6744
DOI:10.1016/S0002-8703(98)70339-4