We have studied the effects of both impaired
prothrombin activation and direct inhibition of
thrombin on the platelet release reaction in clotting blood to determine the role of
thrombin in this process. In blood from two patients with congenital
Factor V deficiency,
prothrombin activation during spontaneous in vitro clotting was delayed and decreased. Secretion of
platelet Factor 4 was also delayed and was detected only after
thrombin formation was initiated. Addition of a small amount of normal plasma to the patients' blood in vitro corrected the abnormalities in both
thrombin formation and the platelet release reaction in parallel fashion. A delay in the onset of secretion of
platelet Factor 4 was also observed when
thrombin generated in normal blood during spontaneous in vitro clotting was inhibited by either purified
hirudin or anti-
thrombin Fab. These observations suggest that
thrombin is the essential stimulus for platelet secretion during in vitro blood clotting. The effect of inhibitors of the platelet release reaction on
prothrombin activation during in vitro blood clotting was also studied. When either
prostacyclin or the combination of prostaglandin E(1) and N(6)O(2')-dibutyryl
cyclic AMP was added, secretion of
platelet Factor 4 was inhibited 85-95%. We were unable to detect any inhibition of initiation of
prothrombin activation or inhibition of that part of
thrombin generation associated with clotting. These results indicate either that the platelet release reaction may not be required for the initiation of
prothrombin activation or only a very limited amount of secretion may be necessary for normal generation of
thrombin to occur.