ADJUNCTIVE THERAPY WITH LOW-MOLECULAR-WEIGHT HEPARIN WITH RECOMBINANT TISSUE-TYPE PLASMINOGEN-ACTIVATOR CAUSES SUSTAINED REFLOW IN CANINE CORONARY-THROMBOSIS

被引:28
作者
NICOLINI, FA
NICHOLS, WW
SALDEEN, TGP
KHAN, S
MEHTA, JL
机构
[1] UNIV FLORIDA, COLL MED, DEPT MED, BOX 100277, GAINESVILLE, FL 32610 USA
[2] UNIV FLORIDA, COLL MED, DEPT PATHOL, GAINESVILLE, FL 32610 USA
[3] VET AFFAIRS MED CTR, DIV CARDIOL, GAINESVILLE, FL USA
[4] UNIV UPPSALA, DEPT FORENS MED, S-75105 UPPSALA, SWEDEN
关键词
D O I
10.1016/0002-8703(92)90588-M
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Rethrombosis of the infarct-related artery after pharmacologic thrombolysis is a major limitation of the thrombolytic therapy. Platelet and fibrin deposition in the coronary artery after recombinant tissue-type plasminogen activator (rTPA) may play a leading role in reformation of thrombus. Therefore we examined the effect of low molecular weight heparin (LMWH) as adjunctive treatment with rTPA in a dog model of electrically induced intracoronary thrombus. Fourteen dogs, in which a stable coronary thrombus was induced with delivery of 100-mu-A of anodal direct current, were randomly given an intravenous bolus of LMWH, 75 IU/kg (n = 6), or saline (n = 8), followed by intravenous rTPA, 1 mg/kg over 20 minutes. LMWH (75 IU/kg) or saline was continuously infused over 90 minutes after rTPA-induced thrombolysis. Reperfusion occurred at 29 +/- 7 minutes in six of eight dogs receiving rTPA plus saline (reperfusion rate 75%), while reperfusion occurred at 18 +/- 3 minutes in all six dogs receiving rTPA plus LMWH (both p = NS versus rTPA plus saline group). Coronary reocclusion occurred in 83% of dogs given rTPA plus saline, but only in one dog (17%) given rTPA plus LMWH (p < 0.05). Magnitude of reflow at 60 minutes of reperfusion was higher in the rTPA plus LMWH group than in the rTPA plus saline group (51 +/- 14 ml/min versus 10 +/- 9 ml/min; p < 0.05). As expected, partial thromboplastin time was greater in rTPA plus LMWH than in rTPA plus saline-treated animals. Scanning electron microscopy (SEM) of coronary arteries showed a totally occlusive thrombus and intense platelet-fibrin deposition in dogs treated with rTPA plus saline. SEM showed a residual partially occlusive thrombus with qualitatively less platelet-fibrin deposition in dogs receiving rTPA plus LMWH. Thus adjunctive therapy with LMWH results in sustained reflow; however, the coronary artery continues to show residual thrombus and platelet-fibrin deposition.
引用
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页码:280 / 288
页数:9
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