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DOI: 10.1055/s-0038-1648940
Markers of Hemostatic Activation in Affected Coronary Arteries during Angioplasty
Publikationsverlauf
Received: 18. März 1994
Accepted after resubmission13. Juli 1994
Publikationsdatum:
06. Juli 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00035024/199405/lookinside/thumbnails/10-1055-s-0038-1648940-1.jpg)
Summary
To characterize the extent of early activation of the hemostatic system following angioplasty, we obtained blood samples from the involved coronary artery of 11 stable angina patients during the procedure and measured sensitive markers of thrombin formation (fibrino-peptide A, prothrombin fragment 1.2, and soluble fibrin) and of platelet activation ((3-thromboglobulin). Levels of hemostatic markers in venous blood obtained from 14 young individuals with low pretest probability for coronary artery disease were not significantly different from levels in venous blood or intracoronary samples obtained prior to angioplasty. Also, there was no translesional (proximal and distal to the lesion) gradient in any of the hemostatic markers before or after angioplasty in samples obtained between 18 and 21 min from the onset of the first balloon inflation. Furthermore, no significant difference was noted between angioplasty and postangioplasty intracoronary concentrations. We conclude that intracoronary hemostatic activation does not occur in the majority of patients during and immediately following coronary angioplasty when high doses of heparin and aspirin are administered.
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References
- 1 Losordo DW, Rosenfield K, Pieczek A, Baker K, Harding M, Isner JM. How does angioplasty work? Serial analysis of human iliac arteries using intravascular ultrasound. Circulation 1992; 86: 1845-1858
- 2 Hoshino T, Yoshida H, Takayama S, Iwase T, Sakata K, Shingu T, Yokoyama S, Mori N, Kaburagi T. Significance of intimal tears in the mechanism of luminal enlargement in PTCA: Correlation of histologic and angiographic findings in postmortem human hearts. Am Heart J 1987; 114: 503-510
- 3 Uchida Y, Hasegawa K, Kawanura K, Shibuya I. Angioscopic observation of the coronary luminal changes induced by percutaneous transluminal coronary angioplasty. Am Heart J 1989; 117: 769-776
- 4 Lam JYT, Chesebro JH, Steele PM, Dewanjee MK, Badimon L, Fuster V. Deep arterial injury during experimental angioplasty: relation to a positive Indium-lll-labeled platelet scintigram, quantitative platelet deposition, and mural thrombosis. J Am Coll Cardiol 1986; 8: 1380-1386
- 5 Ip JH, Fuster V, Israel D, Badimon L, Badimon J, Chesebro J. The role of platelets, thrombin and hyperplasia in restenosis after coronary angioplasty. J Am Coll Cardiol 1991; 17: 77B-88B
- 6 Steele PM, Chesebro JH, Stanson AW, Holmes Jr JR, Dewanjee MK, Badimon L, Fuster V. Balloon angioplasty: natural history of the pathophysiological response to injury in a pig model. Cir Res 1985; 57: 105-112
- 7 Leimgruber PP, Roubin GS, Hollman J, Cotsonis GA, Meier B, Douglas JS, King III SB, Gruentzig AR. Restenosis after successful coronary angioplasty in patients with single-vessel disease. Circulation 1986; 73: 710-717
- 8 Kent KM, Bentivoglio LG, Block PC, Cowley MJ, Dorros G, Gosselin AJ, Gruntzig A, Myler RK, Simpson J, Stertzer SH, Williams DO, Fisher L, Gillespie MJ, Detre K, Sheryl K, Mullin SM, Mock MB. Percutaneous transluminal coronary angioplasty: report from the Registry of the National Heart, Lung, and Blood Institute. Am J Cardiol 1982; 49: 2011-2020
- 9 Walz DA, Anderson GF, Ciaglowski RE, Aiken M, Fenton IIJW. Thrombin-elicited contractile responses of aortic smooth muscle. Proc Soc Exp Biol Med 1985; 85: 518-526
- 10 Hatton MWC, Moar SL, Richardson M. Enhanced binding of fibrinogen by the subendothelium after treatment of the rabbit aorta with thrombin. J Lab Clin Med 1990; 115: 356-364
- 11 Eidt JF, Allison P, Nobel S, Ashton J, Golino P, McNatt J, Buja LM, Wil-lerson JT. Thrombin is an important mediator of platelet aggregation in ste-nosed canine coronary arteries with endothelial injury. J Clin Invest 1989; 84: 18-27
- 12 Jang I-K, Gold HK, Ziskind AA, Leinbach RC, Fallon JT, Collen D. Prevention of platelet-rich arterial thrombosis by selective thrombin inhibition. Circulation 1989; 81: 219-225
- 13 Heras M, Chesebro JH, Penny WJ, Bailey KR, Badimon L, Fuster V. Effects of thrombin inhibition on the development of acute platelet thrombosis deposition during angioplasty in pigs. Circulation 1989; 79: 657-665
- 14 Bar-Shavit R, Benezia M, Eldos A, Hyam E, Fenton JW, Wilner GD, Vlod-savsky I. Thrombin immobilized to extracellular matrix is a potent mitogen for vascular smooth muscle cells. Cell Regulation 1990; 1: 453-463
- 15 Graham DJ, Alexander JJ. The effects of thrombin on bovine aortic endothelial and smooth muscle cells. J Vase Surg 1990; 11: 307-313
- 16 McNamara CA, Sarembock IJ, Gimple LW, Fenton II JW, Coughlin SR, Owens GK. Thrombin stimulates proliferation of cultured rat aortic smooth muscle cells by a proteolytically activated receptor. J Clin Invest 1993; 91: 94-99
- 17 Topol EJ, Bonan R, Jewitt D, Sigwart U, Kakkar VV, Rothman M, de Bono D, Ferguson J, Willerson JT, Strony J, Ganz P, Cohen MD, Raymond R, Fox I, Maraganore J, Adelman B. Use of a direct antithrombin, hirulog, in place of heparin during coronary angioplasty. Circulation 1993; 87: 1622-1629
- 18 Sarembock IJ, Gertz SD, Gimple LW, Owen RM, Powers ER, Roberts WB. Effectiveness of recombinant desulphatohirudin in reducing restenosis after balloon angioplasty of atherosclerotic femoral arteries in rabbits. Circulation 1991; 84: 232-243
- 19 Hursting M, Butman B, Steiner J, Moore B, Plank MC, Szewczyk K, Bell M, Dombrose F. Monoclonal antibodies specific for prothrombin fragment 1.2 and their use in a quantitative enzyme-linked immunosorbent assay. Clin Chem 1993; 39: 583-591
- 20 Soria J, Soria C, Ryckewaert JJ. A solid phase immuno enzymological assay for the measurement of human fibrinopeptide A. Thromb Res 1980; 20: 425-435
- 21 Nossel HL, Ti M, Kaplan KL, Spanondis K, Soland T, Butler JrVP. The generation of fibrinopeptide A in clinical blood samples. Evidence for thrombin activity. J Clin Invest 1976; 58: 1136-1144
- 22 Niewiarowski S, Gurewich V. Laboratory identification of intravascular coagulation. J Lab Clin Med 1971; 77: 665-676
- 23 Gurewich V, Hutchinson E. Detection of intravascular coagulation by a serial dilution protamine sulphate test. Ann Intern Med 1971; 75: 895-902
- 24 Kaplan KL, Owen J. Plasma levels of (3-thromboglobulin and platelet factor 4 as indices of platelet activation in vivo. Thromb Res 1981; 57: 199-202
- 25 Zahari J, Kakkar V. p-thromboglobulin-specific marker of in vivo platelet release reaction. Thromb Haemost 1980; 44: 23-29
- 26 Tofler GH, Brezinski D, Schafer AI, Czeisler CA, Rutherford JD, Willich SN, Gleason RE, Williams GH, Muller JE. Concurrent morning increase in platelet aggregability and the risk of myocardial infarction and sudden cardiac death. N Engl J Med 1987; 316: 1514-1518
- 27 Tahara A, Kohno M, Yanagi S, Itagone H, Toda I, Akioka K, Teragaki M, Yasuda M, Takeuchi K, Takeda T. Circulating immunoreactive endothelin in patients undergoing percutaneous transluminal coronary angioplasty. Metabolism Clinical and Experimental 1991; 40: 1235-1237
- 28 Owen J, Laszlo-Hunter M, Williams JK, Adams M. Thrombin activity induced by balloon angioplasty of the coronary artery in Macaca Fascicularis (cynomolgus monkey). Blood Coagulation and Fibrinolysis 1990; 1: 505-507
- 29 Ring ME, Vecchione JJ, Fiore LD, Ruocco Jr NA, Jacobs AK, Deykin D, Ryan TJ, Faxon DP. Detection of intracoronary fibrin degradation after coronary balloon angioplasty. Am J Cardiol 1991; 67: 1330-1334
- 30 Wilner GD, Danitz MP, Mudd MS, Hsieh K-H, Fenton II JW. Selective immobilization of alpha-thrombin by surface-bound fibrin. J Lab Clin Med 1981; 97: 403-411
- 31 Bar-Shavit R, Eldor A, Vlodavsky I. Binding of thrombin to subendothelial extracellular matrix: protection and expression of functional properties. J Clin Invest 1989; 84: 1096-1104
- 32 Hogg PJ, Jackson CM. Fibrin monomer protects thrombin from inactivation by heparin-antithrombin III. Implications for heparin efficacy. Proc Natl AcadSci 1989; 86: 3619-3623
- 33 Weitz JI, Hudoba M, Massel D, Maraganore J, Hirsh J. Clot-bound thrombin is protected from inhibition by heparin-antithrombin III but is susceptible to inactivation by antithrombin III independent inhibitors. J Clin Invest 1990; 86: 385-391
- 34 Kaiser B, Markwardt F. Experimental studies on the antithrombotic action of a highly effective synthetic thrombin inhibitor. Thromb Haemost 1986; 55: 194-196
- 35 Mao SJT, Yates MT, Owen TJ, Krstenansky JL. Interaction of hirudin with thrombin: identification of a minimal binding domain of hirudin that inhibits clotting activity. Biochemistry 1988; 27: 8170-8173