[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: Xue-qin Jia, Chen-ming Dong, Jing Qin, Ling Zhang
• Journal: Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue (Zhongguo Wei Zhong Bing Ji Jiu Yi Xue) Vol. 24 Issue 4 Pg. 225-8 (Apr 2012) ISSN: 1003-0603 [Print] China
• PMID: 22464576 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, U.S. Gov't, Non-P.H.S.)

Chemical References

• Fibrin Fibrinogen Degradation Products
• Platelet Activating Factor
• fibrin fragment D
• von Willebrand Factor
• Clopidogrel
• Tissue Plasminogen Activator
• Ticlopidine
• Aspirin

Topics

• Adult
• Aged
• Aged, 80 and over
• Angina, Unstable (blood, drug therapy)
• Aspirin (administration & dosage, therapeutic use)
• Blood Coagulation
• Case-Control Studies
• Clopidogrel
• Coronary Disease (blood, drug therapy)
• Double-Blind Method
• Female
• Fibrin Fibrinogen Degradation Products (analysis)
• Fibrinolysis
• Humans
• Male
• Middle Aged
• Myocardial Infarction (blood, drug therapy)
• Platelet Activating Factor (analysis)
• Prospective Studies
• Ticlopidine (administration & dosage, analogs & derivatives, therapeutic use)
• Tissue Plasminogen Activator (blood)
• von Willebrand Factor (analysis)