title: Effect of ACE inhibition on the fibrinolytic system in patients requiring coronary artery bypass grafting.
abstract: BACKGROUND
  Regulation of the fibrinolytic balance between plasminogen activators and inhibitors is modulated by the renin-angiotensin system. Thus, alterations in the renin-angiotensin system by ACE inhibitors probably result in modification of the fibrinolytic system. We examined the effect of a short-term treatment with the ACE inhibitor enalapril in 47 patients with severe coronary artery disease requiring coronary artery bypass grafting (CABG).
  
  
  METHODS
  Patients received either 20 mg/d enalapril or placebo for 6 days. Tissue-type plasminogen activator (TPA), plasminogen activator inhibitor-1 (PAI-1), plasmin-a2-antiplasmin-complex (PAP) and D-dimers were measured initially and after treatment.
  
  
  RESULTS
  In the enalapril group PAI-1 levels were significantly reduced after treatment (11.9 +/- 2.3 U/ml vs. 17.1 +/- 3.0 U/l; P < 0.05). In the placebo group PAP levels were significantly higher ( P < 0.05) after treatment compared to initial values. No differences could be detected between the study groups with regard to TPA and D-dimers.
  
  
  CONCLUSIONS
  Although PAI-1 activity levels are reduced after short-term treatment with ACE inhibitors in patients with stable angina pectoris while TPA antigen is unaffected, treatment with ACE inhibitors does not lead to a marked change in plasmin activation.
authors.affiliation: First Department of Medicine, University Hospital Mannheim, Mannheim, Germany. thomas.walter.med@umm.de
authors.forename: T
authors.initials: T
authors.lastname: Walter
authors.forename: S
authors.initials: S
authors.lastname: Szabo
authors.forename: S
authors.initials: S
authors.lastname: Kazmaier
authors.forename: T
authors.initials: T
authors.lastname: Suselbeck
authors.forename: M
authors.initials: M
authors.lastname: Borggrefe
authors.forename: H M
authors.initials: HM
authors.lastname: Hoffmeister
mesh_terms: D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000097:blood / Q000188:drug therapy* / Q000601:surgery*; D003328:Coronary Thrombosis / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D004311:Double-Blind Method; D004656:Enalapril / Q000627:therapeutic use*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005341:Fibrinolysin / Q000378:metabolism; D005342:Fibrinolysis / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D011446:Prospective Studies; D012084:Renin-Angiotensin System / Q000187:drug effects; D012720:Severity of Illness Index; D010959:Tissue Plasminogen Activator / Q000097:blood; D016896:Treatment Outcome; D000979:alpha-2-Antiplasmin / Q000378:metabolism
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D017395:Plasminogen Activator Inhibitor 1; C051321:SERPINE1 protein, human; D000979:alpha-2-Antiplasmin; C036309:fibrin fragment D; C037742:plasmin-plasmin inhibitor complex; D004656:Enalapril; D010959:Tissue Plasminogen Activator; D005341:Fibrinolysin