Interrelationship between coagulant activity and tissue-type plasminogen activator (t-PA) system in acute ischaemic heart disease. Possible role of the endothelium.
Patients with unstable angina pectoris (UAP; n = 20) and acute myocardial infarction (AMI; n = 34) were studied in the acute phase of ischaemic heart disease. We found significantly higher levels of thrombin-antithrombin-III (TAT) complexes, lower levels of systemic tissue plasminogen activator (t-PA) activity, and higher levels of plasminogen activator inhibitor (PAI) activity in the AMI patients compared to the UAP patients. In contrast to these specific changes, general acute phase reactants such as C-reactive protein, fibrinogen and von Willebrand factor did not differ significantly between the two groups. Studies of the relationship between coagulation (TAT-complexes) and fibrinolysis data revealed a significant positive correlation between plasma antigen concentrations of TAT-complexes and t-PA (P less than 0.02), and between TAT-complexes and PAI-I (P less than 0.002). These observations indicate a common pathophysiological mechanism underlying the changes in coagulation and fibrinolysis, suggesting that coagulation activity and t-PA-related fibrinolysis are interrelated processes in vivo, and probably take place at the level of the endothelial cell.
Department of Clinical Chemistry, Ribe County Hospital, Esbjerg, Denmark.
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Munkvad
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Jespersen
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J
Gram
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Kluft
D000209:Acute-Phase Proteins / Q000032:analysis; D000368:Aged; D000789:Angina, Unstable / Q000097:blood*; D000990:Antithrombin III / Q000032:analysis; D001777:Blood Coagulation / Q000502:physiology*; D004730:Endothelium, Vascular / Q000502:physiology*; D005342:Fibrinolysis / Q000502:physiology; D006801:Humans; D009203:Myocardial Infarction / Q000097:blood*; D010447:Peptide Hydrolases / Q000032:analysis; D015849:Plasminogen Inactivators / Q000097:blood; D010959:Tissue Plasminogen Activator / Q000097:blood*
D000209:Acute-Phase Proteins; D015849:Plasminogen Inactivators; C046193:antithrombin III-protease complex; D000990:Antithrombin III; D010447:Peptide Hydrolases; D010959:Tissue Plasminogen Activator