Concurrent nitroglycerin therapy impairs tissue-type plasminogen activator-induced thrombolysis in patients with acute myocardial infarction.
Nitroglycerin given with tissue-type plasminogen activator (t-PA) has been shown to decrease the thrombolytic effect of t-PA in animal models of coronary artery thrombosis. The present study was conducted to determine whether such an interaction between nitroglycerin and t-PA occurs in patients with acute myocardial infarction undergoing thrombolytic treatment. Patients with acute myocardial infarction were treated with t-PA plus saline solution (group 1; n = 11) or t-PA plus nitroglycerin (group 2; n = 36). Stable coronary artery reperfusion assessed by continuous ST-segment monitoring in 2 electrocardiographic leads, and release of creatine kinase occurred in 91% of group 1 patients and in 44% of group 2 patients (95% confidence interval, 14% to 82%; p < 0.02). Plasma levels of t-PA antigen were consistently (p < 0.005) higher in group 1 than in group 2 patients up to 6 hours after t-PA infusion. Conversely, plasminogen activator inhibitor-1 (PAI-1) levels were slightly higher in group 2 than in group 1 patients. These observations indicate that nitroglycerin given with t-PA significantly decreases the plasma t-PA antigen concentrations and impairs the thrombolytic effect of t-PA in patients with acute myocardial infarction.
Nicolini
F A
FA
Department of Medicine, University of Florida, Gainesville.
Ferrini
D
D
Ottani
F
F
Galvani
M
M
Ronchi
A
A
Behrens
P H
PH
Rusticali
F
F
Mehta
J L
JL
D000368:Aged; D003402:Creatine Kinase / Q000097:blood; D004347:Drug Interactions; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D015425:Myocardial Reperfusion; D005996:Nitroglycerin / Q000627:therapeutic use*; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000097:blood / Q000627:therapeutic use*
D017395:Plasminogen Activator Inhibitor 1; D003402:Creatine Kinase; D010959:Tissue Plasminogen Activator; D005996:Nitroglycerin