Importance of reperfusion on thromboxane A2 metabolite excretion after thrombolysis

Antonio Giuseppe Rebuzzi, Andrea Natale, Claudio Bianchi, Santino Albanese, Gaetano Antonio Lanza, Elda Coppola, Giovanni Ciabattoni

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Abstract

Fibrinolytic therapy is a major advance in the treatment of coronary artery disease. A marked elevation in plasma and urinary metabolites of thromboxane A2 (TXA2) after administration of thrombolytic therapy has been observed and has been related to a direct effect of thrombolytic drugs on platelets. To test this hypothesis we evaluated the 11-dehydrothromboxane B2 (11-d-TXB2) level, as an index of platelet activation, in 20 healthy subjects and in 30 patients with acute myocardial infarction (AMI). Patients with infarction received streptokinase (n = 8), recombinant tissue-type plasminogen activator (rt-PA) (n = 8), or thrombolytic therapy preceded by acetylsalicylic acid (n = 7) or were treated without thrombolytic therapy (n = 7). The urinary 11-d-TXB2 level in healthy control subjects was 327 ± 126 pg/mg creatinine. A significant increase was observed in patients with AMI with no difference between those who received no thrombolytic therapy (673 ± 283 pg/mg creatinine in the first 12 hours) and those who received streptokinase (833 ± 613 pg/mg creatinine) or rt-PA (836 ± 653 pg/mg creatinine). Patients pretreated with acetylsalicylic acid had urinary 11-d-TXB2 values ranging between 361 and 155 pg/mg creatinine. A significant difference in 11-d-TXB2 values was observed only when patients who were reperfused were separated from those who remained occluded according to angiographic criteria (1085 ± 498 vs 391 ± 227 pg/mg creatinine in the first 12 hours, p <0.001). We conclude that reperfusion and not thrombolytic agents per se appears to be the factor that induces platelet activation and consequently facilitates reocclusion.

Original languageEnglish
Pages (from-to)560-566
Number of pages7
JournalAmerican Heart Journal
Volume123
Issue number3
DOIs
Publication statusPublished - 1992

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ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Rebuzzi, A. G., Natale, A., Bianchi, C., Albanese, S., Lanza, G. A., Coppola, E., & Ciabattoni, G. (1992). Importance of reperfusion on thromboxane A2 metabolite excretion after thrombolysis. American Heart Journal, 123(3), 560-566. https://doi.org/10.1016/0002-8703(92)90491-D