Increased serum levels of fibrinogen degradation products due to treatment with recombinant tissue-type plasminogen activator for acute myocardial infarction are related to bleeding complications, but not to coronary patency. European Co-operative Study Groups for rt-PA.
The association of increasing serum levels of fibrinogen degradation products after recombinant tissue-type plasminogen activator (rt-PA) therapy with bleeding and early coronary patency was assessed in 242 patients with acute myocardial infarction. After administration of 5,000 IU heparin, a median of 40 mg (range 35 to 60) of double chain rt-PA was given intravenously in 90 min. Bleeding occurred in 62 patients; in 73% of patients it was observed within the 1st 24 h and 84% of events consisted of hematoma or prolonged bleeding, or both, at puncture sites. Bleeding events occurred 2.12 times as often in patients with serum levels of fibrinogen degradation products greater than 85 mg/liter as in patients with serum levels less than 22 mg/liter (95% confidence interval 1.01 to 4.43). The infarct-related coronary vessel was patent in 65% of patients at 90 min after the start of rt-PA infusion. In patients with high serum levels of fibrin(ogen) degradation products, coronary patency at 90 min after the start of rt-PA infusion was not better (13% less, 95% confidence interval - 33%, 13%) than in patients with low serum levels. This uncoupling of thrombolytic effect in terms of coronary patency and systemic fibrinogenolysis confirms the experimentally demonstrated fibrin specificity of double chain rt-PA in human subjects. Because fibrin specificity of single chain rt-PA is at least similar to that of double chain rt-PA, the observations in this analysis most likely hold also for single chain rt-PA.(ABSTRACT TRUNCATED AT 250 WORDS)
Arnold
A E
AE
Center for Clinical Decision Analysis, Erasmus University, Rotterdam, The Netherlands.
Brower
R W
RW
Collen
D
D
van Es
G A
GA
Lubsen
J
J
Serruys
P W
PW
Simoons
M L
ML
Verstraete
M
M
D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006470:Hemorrhage / Q000139:chemically induced*; D006487:Hemostasis / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000188:drug therapy*; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator / Q000009:adverse effects*; D014654:Vascular Patency / Q000187:drug effects*
D005338:Fibrin Fibrinogen Degradation Products; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator