Effect of ACE inhibition on the fibrinolytic system in patients requiring coronary artery bypass grafting.
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.
Walter
T
T
First Department of Medicine, University Hospital Mannheim, Mannheim, Germany. thomas.walter.med@umm.de
Szabo
S
S
Kazmaier
S
S
Suselbeck
T
T
Borggrefe
M
M
Hoffmeister
H M
HM
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
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