Fibrinogen breakdown, long-lasting systemic fibrinolysis, and procoagulant activation during alteplase double-bolus regimen in acute myocardial infarction

The American Journal of Cardiology
K StanglS Ziemer

Abstract

Recent clinical studies comparing accelerated versus bolus administration of alteplase tissue plasminogen activator (t-PA) suggest similar thrombolytic efficacy, but reveal higher bleeding complications among older patients during the double-bolus regimen. The objective of the present study was to characterize the hemostatic profile of t-PA administered as double-bolus doses of 50 mg, at intervals of 30 minutes. Among 50 patients with acute myocardial infarction treated by double-bolus t-PA thrombolysis, coagulation and fibrinolysis parameters, as well as t-PA levels, were monitored. Monitored t-PA levels peaked at 5 and 35 minutes and were detectable within the therapeutic range even after 90 minutes. Marked systemic fibrinolytic activation was indicated by 75% depletion of both plasminogen and fibrinogen, as well as by 19-fold and 300-fold increases of fibrin degradation and fibrinogen degradation products. Plasminogen-activator inhibitor activity was completely suppressed. Pronounced procoagulant activation was reflected by a 3.4-fold increase of both factor XIIa and prothrombin fragment 1+2, and by a threefold increase of thrombin-antithrombin complex. Independent of t-PA weight dosage, fibrinolytic activation was more pron...Continue Reading

References

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Citations

Jan 15, 2014·Journal of Controlled Release : Official Journal of the Controlled Release Society·Shahriar AbsarFakhrul Ahsan
Sep 21, 2011·Journal of Controlled Release : Official Journal of the Controlled Release Society·Shahriar AbsarYoung M Kwon
Nov 3, 2012·British Journal of Haematology·Mike MakrisUNKNOWN British Committee for Standards in Haematology
Dec 17, 2014·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Laura VandelliAndrea Zini
Dec 13, 2005·Stroke; a Journal of Cerebral Circulation·Roland VeltkampWerner Hacke
Aug 8, 2008·Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis·Orieji C Illoh, Kachi Illoh
Dec 29, 2020·Frontiers in Neurology·Benjamin MaïerMikael Mazighi
Apr 13, 2021·BioImpacts : BI·Young M Kwon
Jun 24, 2021·Journal of Thrombosis and Thrombolysis·Keaton S SmetanaShahid M Nimjee

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