COAGULATION, FIBRINOLYTIC, AND INHIBITORY PROTEINS IN ACUTE MYOCARDIAL-INFARCTION AND ANGINA-PECTORIS

被引:75
作者
VAZIRI, ND [1 ]
KENNEDY, SC [1 ]
KENNEDY, D [1 ]
GONZALES, E [1 ]
机构
[1] UNIV CALIF IRVINE, DEPT MED, IRVINE, CA 92717 USA
关键词
D O I
10.1016/0002-9343(92)90198-K
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND AND METHOD: The role of thrombus formation in the pathogenesis of acute myocardial infarction (AMI) and unstable pectoris has been well established. However, comprehensive and systematic studies of the blood coagulation, fibrinolytic, and inhibitory proteins are not available in patients with these conditions. Fourteen patients with AMI, 10 patients with angina pectoris, and 32 normal volunteers were studied. Plasma antigen concentrations and/or activities of high-molecular-weight kininogen (HMWK), fibrinogen, fibronectin, plasminogen, D-dimer, tissue plasminogen activator (t-PA), alpha2-antiplasminogen alpha2-macroglobulin, alpha1-antitrypsin, protein C, total and free protein S, antithrombin III (AT-III), von Willebrand factor (vWF), factors (F) XII, XI, IX, VIII, VII, X, V, II, and XIII, and plasma antiplasmin activity were measured using appropriate functional or immunologic assays. RESULTS: The AMI group showed a significant reduction in F XII activity, F XII activity-to-concentration ratio, and HMWK concentration. In addition, the AMI patients exhibited a significant elevation of plasma F XI activity, F IX concentration, and F IX activity, and vWF, ribrinogen, D-dimer, and t-PA concentrations. This was associated with significant reductions in F V, F II, and AT-III activity-to-concentration ratio. Many of the changes observed in AMI patients were also present in patients with angina pectoris. Furthermore, the latter group exhibited an elevation of F VM activity, alpha2-macroglobulin activity, and alpha1-antitrypsin concentration and a significant reduction of antiplasmin activity despite a normal alpha2-antiplasmin concentration. CONCLUSIONS: The observed reduction of the plasma F XII activity-to-antigen concentration ratio combined with a reduced HMWK concentration suggests intrinsic pathway activation, while the elevation of the D-dimer concentration indicates thrombin generation and fibrin formation and degradation in the AMI group. The latter changes were also present in patients with angina pectoris. Both AMI and angina groups showed several other abnormalities of the coagulation, fibrinolytic, and inhibitory systems. The results suggest the presence of a prothrombotic state associated with the activation of coagulation and fibrinolytic systems in patients with acute myocardial ischemia or infarction.
引用
收藏
页码:651 / 657
页数:7
相关论文
共 20 条
[1]  
[Anonymous], 1988, LANCET, V2, P349
[2]  
BERK BC, 1990, J BIOL CHEM, V265, P17334
[3]   UNSTABLE ANGINA WITH FATAL OUTCOME - DYNAMIC CORONARY THROMBOSIS LEADING TO INFARCTION AND OR SUDDEN-DEATH - AUTOPSY EVIDENCE OF RECURRENT MURAL THROMBOSIS WITH PERIPHERAL EMBOLIZATION CULMINATING IN TOTAL VASCULAR OCCLUSION [J].
FALK, E .
CIRCULATION, 1985, 71 (04) :699-708
[4]   PLASMA-FIBRINOGEN LEVELS AS AN INDEPENDENT INDICATOR OF SEVERITY OF CORONARY ATHEROSCLEROSIS [J].
HANDA, K ;
KONO, S ;
SAKU, K ;
SASAKI, J ;
KAWANO, T ;
SASAKI, Y ;
HIROKI, T ;
ARAKAWA, K .
ATHEROSCLEROSIS, 1989, 77 (2-3) :209-213
[5]   ASPIRIN AND OTHER ANTIPLATELET AGENTS IN THE SECONDARY AND PRIMARY PREVENTION OF CARDIOVASCULAR-DISEASE [J].
HENNEKENS, CH ;
BURING, JE ;
SANDERCOCK, P ;
COLLINS, R ;
PETO, R .
CIRCULATION, 1989, 80 (04) :749-756
[6]  
HUANG CL, 1987, J BIOL CHEM, V262, P14134
[7]  
Hultin M B, 1991, Prog Hemost Thromb, V10, P215
[8]  
IP JH, 1991, J AM COLL CARDIOL, V17, pB77
[9]   FIBRIN AND FIBRINOGEN-RELATED ANTIGENS IN PATIENTS WITH STABLE AND UNSTABLE CORONARY-ARTERY DISEASE [J].
KRUSKAL, JB ;
COMMERFORD, PJ ;
FRANKS, JJ ;
KIRSCH, RE .
NEW ENGLAND JOURNAL OF MEDICINE, 1987, 317 (22) :1361-1365
[10]   ELECTROIMMUNO ASSAY [J].
LAURELL, CB .
SCANDINAVIAN JOURNAL OF CLINICAL & LABORATORY INVESTIGATION, 1972, 29 :21-&