[Non ST elevation acute coronary syndrome. Parameters of fibrinolysis during short term use of ticlopidine or clopidogrel].
Whether thienopyridines (ticlopidine or clopidogrel) produce similar effects on fibrinolysis in patients with non ST elevation acute coronary syndrome (NSTEACS) was not well elucidated.


OBJECTIVE
To study changes of parameters of fibrinolysis during short term use of ticlopidine and clopidogrel in NSTEACS patients treated with aspirin and antithrombin.


METHODS
Patients with NSTEACS treated with aspirin and unfractionated heparin (UFH, n=37) or enoxaparin (n=19).


METHODS
The UFH treated patients were randomized to ticlopidine (1000 mg/day for 2 and then 500 mg/day for 5 days, n=19) or no ticlopidine (n=18). Enoxaparin treated patients were randomized to either clopidogrel (300 mg/day for 1 and then 75 mg/day for 6 days, n=10) or no clopidogrel (n=9). Levels of tissue plasminogen activator (TPA) antigen, D-dimer, and activity of plasminogen activator inhibitor (PAI) were measured before and in 24 hours, 3, 7, 14 days after randomization.


RESULTS
At baseline values of parameters studied were similar in each pair (thienopiridine - control) of patients groups. Compared with their controls ticlopidine treated patients on day 7 had less pronounced lowering of PAI activity (13.6 and 8.2 U/l, p<0.05) and lower D-dimer concentration (515 and 770 ng/ml, respectively, p<0.05). Clopidogrel treated patients on days 3, 7 and 14 had higher levels of TPA both compared with controls (25.7 and 20.2, p<0.05; 26.5 and 12.9, p<0.01; 24.6 and 15.7 ng/ml, p<0.01; respectively) and baseline. D-dimer levels in these patients on same time points were also higher than in controls (969 and 702, p<0.05, 970 and 575, p<0.01, 806 and 484 ng/ml, p<0.01, respectively).


CONCLUSIONS
Compared with controls the use of ticlopidine in patients with NSTEACS treated with aspirin and UFH was associated with less pronounced lowering of PAI activity and lower level of D-dimer. This could be interpreted as consequence of inhibition of fibrinolysis. The use of clopidogrel in similar patients treated with aspirin and enoxaparin was associated with elevated levels of TPA and D-dimer what presumably reflected augmentation of fibrinolytic activity.
Slavina
N N
NN
Tsentr ateroskleroza NII fiziko-khimicheskoĭ meditsiny, Moskva.
Averkov
O V
OV
Dobrovol'skiĭ
A B
AB
Gratsianskiĭ
N A
NA
D000208:Acute Disease; D000328:Adult; D000991:Antithrombins / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D000077144:Clopidogrel; D003327:Coronary Disease / Q000188:drug therapy / Q000503:physiopathology*; D004359:Drug Therapy, Combination; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects*; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D013577:Syndrome; D013988:Ticlopidine / Q000008:administration & dosage* / Q000031:analogs & derivatives* / Q000494:pharmacology*; D013997:Time Factors
D000991:Antithrombins; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin