title: A pilot study of streptokinase-induced endothelial injury and platelet activation following acute myocardial infarction.
abstract: OBJECTIVE
  To relate the changes in serum vitamin E, an essential antioxidant, to changes in fibrinogen, as well as indices of endothelial damage [as indicated by plasma markers, soluble thrombomodulin (sTM) and von Willebrand factor (vWf), and an index of platelet activation (soluble P selectin (sPsel)], in myocardial infarction treated with thrombolytic therapy.
  
  
  METHODS
  Prospective longitudinal pilot study in a teaching hospital Coronary Care Unit.
  
  
  METHODS
  Seventeen patients (12 men: mean age (62 years +/- SD 11 years) admitted with acute myocardial infarction (AMI), who were given thrombolytic therapy, and 59 healthy controls.
  
  
  RESULTS
  Baseline levels of fibrinogen (Mann-Whitney test, P = 0.0055) and vWf (P < 0.001) were significantly higher than controls, but sPsel, sTM or vitamin E levels were not significantly different. Following thrombolysis, as expected, median concentrations of plasma fibrinogen fell profoundly (Friedman ANOVA P < 0.001) so that after 45 min, levels were undetectable in 13 patients. At 24-h median fibrinogen concentration had recovered to approximately 30% of baseline (P < 0.01) and was still undetectable in three patients. Levels of vWf and sPsel increased steadily, reaching significance after three hours (both P < 0.05). However, levels of sTM rose immediately after thrombolysis, peaking between 1 and 3 h, and remained elevated at 24 h. These increases corresponded to a simultaneous early fall in serum vitamin E concentrations.
  
  
  CONCLUSIONS
  The present pilot study demonstrates significant endothelial damage and platelet activation in association with increased oxidative stress following streptokinase therapy for AMI.
authors.affiliation: University Department of Medicine, City Hospital, Birmingham, UK. G.Y.H.LIP@bham.ac.uk
authors.forename: G Y
authors.initials: GY
authors.lastname: Lip
authors.forename: C
authors.initials: C
authors.lastname: Lydakis
authors.forename: S L
authors.initials: SL
authors.lastname: Nuttall
authors.forename: M J
authors.initials: MJ
authors.lastname: Landray
authors.forename: R D
authors.initials: RD
authors.lastname: Watson
authors.forename: A D
authors.initials: AD
authors.lastname: Blann
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D016022:Case-Control Studies; D004730:Endothelium, Vascular / Q000187:drug effects*; D005260:Female; D005340:Fibrinogen / Q000187:drug effects / Q000378:metabolism*; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000188:drug therapy*; D018384:Oxidative Stress / Q000187:drug effects; D019007:P-Selectin / Q000097:blood* / Q000187:drug effects; D010865:Pilot Projects; D015539:Platelet Activation / Q000187:drug effects*; D011446:Prospective Studies; D013300:Streptokinase / Q000009:adverse effects*; D018180:Thrombomodulin / Q000097:blood* / Q000187:drug effects; D014810:Vitamin E / Q000097:blood*; D014841:von Willebrand Factor / Q000187:drug effects / Q000378:metabolism*
chemical_list: D005343:Fibrinolytic Agents; D019007:P-Selectin; D018180:Thrombomodulin; D014841:von Willebrand Factor; D014810:Vitamin E; D005340:Fibrinogen; D013300:Streptokinase