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Plasma levels of plasminogen activator inhibitor type 1, beta-
thromboglobulin, and fibrinopeptide A before, during, and after treatment
of acute myocardial infarction with alteplase
HJ Rapold, V Grimaudo, PJ Declerck, EK Kruithof and F Bachmann
Department of Medicine, University Hospital of Lausanne, Switzerland.
Plasma levels of plasminogen activator inhibitor type-1 (PAI-1), beta-
thromboglobulin (beta TG), and fibrinopeptide A (FPA) were followed over 24
hours in 30 patients treated with alteplase for acute myocardial
infarction. Samples were taken at baseline (T Oh), after 90 minutes (under
alteplase, no heparin, T 1.5h), after 120 minutes (under alteplase and
heparin, T 2h), 30 minutes after thrombolytic therapy (T 3.5h), as well as
12 hours (T 12h) and 24 hours (T 24h) after baseline. PAI-1 antigen levels
(55 +/- 9 ng/mL at T Oh, mean +/- SEM) decreased to 35 +/- 5 (T 1.5h) and
40 +/- 6 (T 2h) ng/mL under alteplase, before increasing to 84 +/- 22 (T
3.5h), 130 +/- 30 (T 12h), and 64 +/- 7 (T 24h) ng/mL after therapy, P less
than .001. A high baseline PAI-1 activity (18 +/- 3 ng/mL) decreased to 2.0
+/- 0.4 (T 1.5h) and 1.7 +/- 0.2 (T 2h) under alteplase and increased to 32
+/- 5 (T 12h) and 19 +/- 3 (T 24h) ng/mL after therapy (P less than .0001).
beta TG levels (339 +/- 105 ng/mL at T Oh) decreased to 203 +/- 48 (T 2h),
154 +/- 51 (T 3.5h), 187 +/- 40 (T 12h), and 142 +/- 32 (T 24h) ng/mL under
heparin (P less than .01). FPA levels (34 +/- 9 ng/mL at T Oh) increased to
85 +/- 15 ng/mL under alteplase alone (T 1.5h) and normalized under heparin
(11 +/- 4, 6 +/- 2, 4 +/- 2, and 3 +/- 1 ng/mL at T 2h, T 3.5h, T 12h, and
T 24h, respectively). A high level of FPA at T 3.5h correlated with
reocclusion (33 +/- 12 ng/mL, n = 4 v 2.9 +/- 0.5 ng/mL, n = 21, P less
than .005). We conclude that plasma levels of PAI- 1 antigen as well as
activity markedly increase after alteplase therapy of acute myocardial
infarction. The high activity of PAI-1 and decreasing beta TG levels
suggest that platelets do not contribute significantly to this phenomenon.
The marked increase of FPA levels under recombinant tissue-type plasminogen
activator alone and its normalization under heparin emphasize the important
role of concomitant anticoagulation in controlling further intravasal
fibrin generation under alteplase.
Volume 78,
Issue 6,
pp. 1490-1495,
09/15/1991
Copyright © 1991 by The American Society of Hematology
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