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Thrombin generation, inhibition and clinical outcomes in patients with acute myocardial infarction treated with thrombolytic therapy and heparin: results from the GUSTO-I Trial. GUSTO-I Hemostasis Substudy Group. Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries.

Publication ,  Journal Article
Granger, CB; Becker, R; Tracy, RP; Califf, RM; Topol, EJ; Pieper, KS; Ross, AM; Roth, S; Lambrew, C; Bovill, EG
Published in: J Am Coll Cardiol
March 1, 1998

OBJECTIVES: We sought to assess the effects of antithrombotic therapy after thrombolysis for acute myocardial infarction on markers of thrombin generation and activity and to determine the relation of these markers with clinical outcomes. BACKGROUND: Thrombin activation and generation often occur with thrombolysis for acute myocardial infarction. Antithrombotic regimens have been developed to reduce the resulting thrombotic complications. METHODS: We sampled plasma markers of thrombin generation and activity after thrombolysis in 292 patients. We assessed the relations of these markers with clinical outcomes at 30 days. RESULTS: Fibrinopeptide A (FPA), a marker of thrombin activity toward fibrinogen, was elevated at baseline (12.3 ng/ml) and increased to 18.4 ng/ml by 90 min after streptokinase and subcutaneous heparin treatment. With intravenous heparin, this increase was attenuated, but intravenous heparin did not prevent thrombin generation, as measured by prothrombin fragment 1.2 (F1.2). Heparin level, measured by anti-Xa activity, correlated with activated partial thromboplastin time (aPTT, r = 0.62 to 0.67). Thrombin activity, measured by FPA, was as closely related to aPTT as to the heparin level. Baseline levels of F1.2 were significantly related to the risk of death or reinfarction at 30 days (p = 0.008); values 12 h after enrollment also were related to 30-day mortality (p = 0.05). CONCLUSIONS: Although intravenous heparin partly suppresses the increased thrombin activity associated with thrombolysis, it does not inhibit thrombin generation. The aPTT was as good a measure of suppression of thrombin activity as the heparin level itself. Hematologic markers of thrombin generation were found to be related to the subsequent risk of thrombotic events.

Duke Scholars

Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

March 1, 1998

Volume

31

Issue

3

Start / End Page

497 / 505

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Thrombosis
  • Thrombolytic Therapy
  • Thrombin
  • Streptokinase
  • Peptide Hydrolases
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Injections, Subcutaneous
 

Citation

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ICMJE
MLA
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Granger, C. B., Becker, R., Tracy, R. P., Califf, R. M., Topol, E. J., Pieper, K. S., … Bovill, E. G. (1998). Thrombin generation, inhibition and clinical outcomes in patients with acute myocardial infarction treated with thrombolytic therapy and heparin: results from the GUSTO-I Trial. GUSTO-I Hemostasis Substudy Group. Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries. J Am Coll Cardiol, 31(3), 497–505. https://doi.org/10.1016/s0735-1097(97)00539-1
Granger, C. B., R. Becker, R. P. Tracy, R. M. Califf, E. J. Topol, K. S. Pieper, A. M. Ross, S. Roth, C. Lambrew, and E. G. Bovill. “Thrombin generation, inhibition and clinical outcomes in patients with acute myocardial infarction treated with thrombolytic therapy and heparin: results from the GUSTO-I Trial. GUSTO-I Hemostasis Substudy Group. Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries.J Am Coll Cardiol 31, no. 3 (March 1, 1998): 497–505. https://doi.org/10.1016/s0735-1097(97)00539-1.
Journal cover image

Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

March 1, 1998

Volume

31

Issue

3

Start / End Page

497 / 505

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Thrombosis
  • Thrombolytic Therapy
  • Thrombin
  • Streptokinase
  • Peptide Hydrolases
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Injections, Subcutaneous