title: [Changes in coagulation and fibrinolysis in the patients with coronary heart disease in acute period and effect of drug intervention].
abstract: OBJECTIVE
  To investigate the changes in coagulation and fibrinolysis parameters during acute phase of coronary heart disease, and to explore the effects of drug intervention in same period.
  
  
  METHODS
  A prospective study was conducted. The changes in plasma von Willebrand factor (vWF), platelet activating factor (PAF), tissue type plasminogen activator (t-PA) of 110 patients with coronary heart disease [50 patients with acute myocardial infarction (AMI), 35 patients with unstable angina pectoris (UAP), 25 patients with ischemic cardiomyopathy (ICM)] were determined immediately at admission and 14 days after treatment. The indexes of 19 healthy individuals were collected as control. At the same time, randomized and double-blind observation of the changes in plasma coagulation and fibrinolysis system indexes including vWF, PAF and t-PA was made in AMI and UAP patients who received conventional treatment (aspirin + low molecular weight heparin) or combination of conventional treatment and clopidogrel for 14 days.
  
  
  RESULTS
  The vWF and PAF levels (nmol/L) of AMI and UAP patients at admission were significantly higher than those in healthy control group [vWF: (202.31 ± 27.38)%, (188.65 ± 31.08)%  vs.  (120.37 ± 18.79)%; PAF: 50.64 ± 13.25, 48.87 ± 13.24  vs.  15.43 ± 9.27, all P < 0.05], however, t-PA (μg/L) was remarkably lower than that in healthy control group (3.52 ± 1.57, 4.03 ± 2.04  vs.  9.54 ± 1.32, both P < 0.01). After 14 days of treatment, the levels of vWF, PAF, t-PA, fibrinogen (Fib, g/L), D-dimer (mg/L) in plasma of AMI and UAP patients were close to those of healthy control group [vWF: (116.56 ± 26.10)%, (111.28 ± 22.31)%  vs.  (120.37 ± 18.79)%; PAF: 17.48 ± 9.16, 16.23 ± 9.17  vs.  15.43 ± 9.27; t-PA: 7.91 ± 2.42, 9.01 ± 2.01  vs.  9.54 ± 1.32; Fib: 3.64 ± 0.53, 2.74 ± 0.72  vs.  2.92 ± 0.91; D-dimer: 0.370 ± 0.150, 0.288 ± 0.169  vs.  0.255 ± 0.109, all P>0.05]. However, there was no statistical difference in vWF, PAF, t-PA, Fib and D-dimer levels before and after treatment in ICM group compared with healthy control group [vWF: (124.14 ± 21.17)%, (119.44 ± 26.28)%  vs.  (120.37 ± 18.79)%; PAF: 15.69 ± 7.14, 14.84 ± 9.16  vs.  15.43 ± 9.27; t-PA: 8.62 ± 2.24, 8.07 ± 2.51  vs.  9.54 ± 1.32; Fib: 3.24 ± 0.74, 3.04 ± 0.77  vs.  2.92 ± 0.91; D-dimer: 0.257 ± 0.132, 0.268 ± 0.117  vs.  0.255 ± 0.109, all P>0.05]. Multiple linear regression analysis showed that, in patients with coronary heart disease, PAF be positively correlated with vWF (r = 0.42, P < 0.01), but negatively correlated with t-PA (r = -0.31, P < 0.01). In patients with AMI and UAP, using the treatment of clopidogrel for 14 days, the levels of vWF, PAF, t-PA, Fib and D-dimer in plasma showed no significant differences compared with those of conventional treatment group [vWF: (120.16 ± 16.57)%  vs.  (118.12 ± 14.32)%; PAF: 12.01 ± 3.70  vs.  13.33 ± 1.10; t-PA: 9.75 ± 1.60  vs.  7.59 ± 2.46; Fib: 2.73 ± 0.49  vs.  3.09 ± 0.50; D-dimer: 0.233 ± 0.101  vs.  0.252 ± 0.088, all P>0.05].
  
  
  CONCLUSIONS
  There were changes in coagulation and fibrinolysis status in patients with AMI and UAP at the initial stage, the level of t-PA was decreased significantly. For patients with AMI and UAP, there were no obvious differences in coagulation and fibrinolysis parameters between combination therapy of clopidogrel and aspirin and aspirin alone.
authors.affiliation: Department of Emergency, the Second Hospital of Lanzhou University, Lanzhou 730030, Gansu, China. jiaxueqin656422@163.com
authors.forename: Xue-qin
authors.initials: XQ
authors.lastname: Jia
authors.forename: Chen-ming
authors.initials: CM
authors.lastname: Dong
authors.forename: Jing
authors.initials: J
authors.lastname: Qin
authors.forename: Ling
authors.initials: L
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000097:blood / Q000188:drug therapy; D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use*; D001777:Blood Coagulation; D016022:Case-Control Studies; D000077144:Clopidogrel; D003327:Coronary Disease / Q000097:blood* / Q000188:drug therapy; D004311:Double-Blind Method; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005342:Fibrinolysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000188:drug therapy; D010972:Platelet Activating Factor / Q000032:analysis; D011446:Prospective Studies; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010959:Tissue Plasminogen Activator / Q000097:blood; D014841:von Willebrand Factor / Q000032:analysis
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; D010972:Platelet Activating Factor; C036309:fibrin fragment D; D014841:von Willebrand Factor; D000077144:Clopidogrel; D010959:Tissue Plasminogen Activator; D013988:Ticlopidine; D001241:Aspirin