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A pilot study of streptokinase‐induced endothelial injury and platelet activation following acute myocardial infarction
Author(s) -
Lip G. Y. H.,
Lydakis C.,
Nuttall S. L.,
Landray M. J.,
Watson R. D. S.,
Blann A. D.
Publication year - 2000
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1046/j.1365-2796.2000.00738.x
Subject(s) - medicine , myocardial infarction , thrombolysis , fibrinogen , von willebrand factor , streptokinase , endothelial activation , thrombosis , platelet activation , platelet , coronary care unit , cardiology , gastroenterology , endothelium
. Lip GYH, Lydakis C, Nuttall SL, Landray MJ, Watson RDS, Blann AD (Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK). A pilot study of streptokinase‐induced endothelial injury and platelet activation following acute myocardial infarction. J Intern Med 248: 316–318. Objective. To relate the changes in serum vitamin E, an essential antioxidant, to changes in fibrinogen, as well as indices of endothelial damage [as indicated by plasma markers, soluble thrombomodulin (sTM) and von Willebrand factor (vWf)], and an index of platelet activation [soluble P selectin (sPsel)], in myocardial infarction treated with thrombolytic therapy. Design and Setting. Prospective longitudinal pilot study in a teaching hospital Coronary Care Unit. Subjects and intervention. Seventeen patients (12 men; mean age 62 years ± SD 11 years) admitted with acute myocardial infarction (AMI), who were given thrombolytic therapy, and 59 healthy controls. Results. Baseline levels of fibrinogen (Mann–Whitney test, P = 0.0055) and vWf ( P < 0.001) were significantly higher than controls, but sPsel, sTM or vitamin E levels were not significantly different. Following thrombolysis, as expected, median concentrations of plasma fibrinogen fell profoundly (Friedman anova P < 0.001) so that after 45 min, levels were undetectable in 13 patients. At 24‐h median fibrinogen concentration had recovered to approximately 30% of baseline ( P < 0.01) and was still undetectable in three patients. Levels of vWf and sPsel increased steadily, reaching significance after three hours (both P < 0.05). However, levels of sTM rose immediately after thrombolysis, peaking between 1 and 3 h, and remained elevated at 24 h. These increases corresponded to a simultaneous early fall in serum vitamin E concentrations. Conclusion. The present pilot study demonstrates significant endothelial damage and platelet activation in association with increased oxidative stress following streptokinase therapy for AMI.