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Effect of thrombolysis on myocardial injury: recombinant tissue plasminogen activator vs. alfimeprase.

Abstract
Plasmin-dependent thrombolytic agents are potentially prothrombotic and proinflammatory. Alfimeprase, a zinc-containing metalloproteinase, degrades fibrin directly and achieves thrombolysis independent of plasmin formation. This study examines the hypothesis that thrombolysis in the absence of plasmin generation results in improved myocardial salvage on reperfusion. The thrombolytic effects of recombinant tissue plasminogen activator [rt-PA; 0.022 mg/kg, 1/10 of which was administered as a loading dose; the rest (9/10) was infused over 60 min by intracoronary (ic) administration] or alfimeprase (0.5 mg/kg over 1 min ic) were evaluated in a canine model of arterial thrombosis involving electrolytic injury of the left circumflex (LCX) coronary artery. Both agents induced thrombolysis, with onset of reperfusion being more rapid after alfimeprase compared with rt-PA (1.5 +/- 0.6 vs. 10.1 +/- 2.1 min). In the absence of adjunctive therapy, time to reocclusion after alfimeprase was 3.2 +/- 0.5 min compared with 77.5 +/- 31.9 min with rt-PA. The glycoprotein IIb/IIIa platelet receptor antagonist CRL-42796 prolonged reperfusion time after thrombolysis with alfimeprase or rt-PA. The effect of each lytic agent on myocardial infarct size was examined in a separate group of dogs subjected to 60 min of LCX coronary artery ligation and 4 h of reperfusion. Myocardial infarct size, expressed as percentage of the risk region, was larger (32.16 +/- 3.95%) after rt-PA compared with alfimeprase (19.85 +/- 3.61%) or that of the saline control group (18.46 +/- 3.34%). rt-PA in contrast to alfimeprase, a direct-acting fibrinolytic agent, is associated with an increase in myocyte reperfusion injury.
AuthorsTing-Ting Hong, Jinbao Huang, Benedict R Lucchesi
JournalAmerican journal of physiology. Heart and circulatory physiology (Am J Physiol Heart Circ Physiol) Vol. 290 Issue 3 Pg. H959-67 (Mar 2006) ISSN: 0363-6135 [Print] United States
PMID16243915 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Fibrinolytic Agents
  • Recombinant Proteins
  • Tissue Plasminogen Activator
  • Metalloendopeptidases
  • alfimeprase
Topics
  • Animals
  • Dogs
  • Fibrinolytic Agents (administration & dosage)
  • Metalloendopeptidases (administration & dosage)
  • Myocardial Reperfusion Injury (diagnosis, drug therapy)
  • Recombinant Proteins (administration & dosage)
  • Recovery of Function (drug effects)
  • Thrombolytic Therapy (methods)
  • Tissue Plasminogen Activator (administration & dosage, genetics)
  • Treatment Outcome

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