Thromb Haemost 1993; 69(03): 268-271
DOI: 10.1055/s-0038-1651593
Original Article
Platelets
Schattauer GmbH Stuttgart

Potentiating Effect of Clopidogrel and SR 46349, a Novel 5-HT2 Antagonist, on Streptokinase-Induced Thrombolysis in the Rabbit

J M Herbert
Sanofi Recherche, Toulouse, France
,
A Bernat
Sanofi Recherche, Toulouse, France
,
M Sainte-Marie
Sanofi Recherche, Toulouse, France
,
F Dol
Sanofi Recherche, Toulouse, France
,
M Rinaldi
1   Sanofi Recherche, Montpellier, France
› Author Affiliations
Further Information

Publication History

Received 23 July 1992

Accepted after revision 26 October 1992

Publication Date:
05 July 2018 (online)

Summary

Current thrombolytic strategies have a number of important shortcomings including resistance to recanalization and development of acute reocclusion. The purpose of this study was to investigate whether the lysis of venous thrombi by streptokinase could be enhanced by SR 46349, a novel 5-HT2 receptor antagonist, or clopidogrel, an analogue of ticlopidine. The activity of these compounds was evaluated by following the lysis of radiolabelled fibrin under a continuous infusion of streptokinase (4,000 IU kg−1 h−1 over 4 h). Streptokinase alone induced 42% thrombolysis when compared to saline. The i. v. co-administration of SR 46349 or clopidogrel (10 mg/kg) enhanced significantly streptokinase-induced thrombolysis. Thrombolysis measured by [125I]-fibrinogen lysis increased to 65 and 59% respectively. This efficacy was achieved without additional prolongation of the template bleeding time observed with streptokinase alone.

Thus, the concomitant use of a 5-HT2 receptor antagonist or an anti-ADP agent during streptokinase therapy may facilitate clot lysis.

 
  • References

  • 1 Sheehan FH, Braunwald E, Canner P. co-investigators. The effects of intravenous thrombolytic therapy on left ventricular function: a report on tissue-type plasminogen activator and streptokinase from the Thrombolysis in Myocardial Infarction (TIMI Phase I) Trial. Circulation 1987; 75: 817-829
  • 2 Collen D, Topol EJ, Tiefenbrunn AJ, Gold HK, Weisfeldt ML, Sobel BE, Leinbach RC, Brinker JA, Ludbrook PA, Yashuda T, Bulkley BH, Robinson AK, Hutter AM, Bell WR, Spadaro JJ, Khaw BA, Grossbard EB. Coronary thrombolysis with recombinant human tissue-type plasminogen activator: a prospective, randomized-placebo controlled trial. Circulation 1984; 70: 1012-1017
  • 3 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
  • 4 Willerson JT, Golino P, McNatt J, Eidt J, Yao SK, Buja LM. Role of new antiplatelet agents as adjunctive therapies is thrombolysis. Am J Cardiol 1991; 67: 12A-18A
  • 5 Yashuda T, Gold HK, Yaoita H, Leinbach RC, Guerrero JL, Jang IK, Holt R, Fallon JT, Collen D. Comparative effects of aspirin, a synthetic thrombin inhibitor and a monoclonal antiplatelet glycoprotein IIb/IIIa antibody on coronary artery reperfusion, reocclusion and bleeding with recombinant tissue-type plasminogen activator in a canine preparation. J Am Coll Cardiol 1990; 16: 714-722
  • 6 Golino P, Ashton JH, McNatt J, Glas-Greenwalt P, Shen-Kun Y, O’Brien RA, Buja LM, Willerson JT. Simultaneous administration of thromboxane A2- and serotonin S2-receptor antagonists markedly enhances thrombolysis and prevents or delays recclusion after tissue-type plasminogen activator in a canine model of coronary thrombosis. Circulation 1989; 79: 911-919
  • 7 Golino P, Ashton JH, Glas-Greenwalt P, McNatt J, Bruja LM, Willerson JT. Mediation of reocclusion by thromboxane A2 and serotonin after thrombolysis with tissue-type plasminogen activator in a canine preparation of coronary thrombosis. Circulation 1988; 77: 678-684
  • 8 Yasuda T, Gold HK, Leinbach RC, Saito T, Guerrero JL, Jang IK, Holt R, Fallon JT, Collen D. Lysis of plasminogen activator-resistant platelet-rich coronary artery thrombus with combined blus injection of recombinant tissue-type plasminogen activator and antiplatelet GPIIb/IIIa antibody. J Am Coll Cardiol 1990; 16: 1728-1735
  • 9 Vaughan DE, Plavin SR, Schafer AI, Loscalzo J. PGE1 accelerates thrombolysis by tissue plasminogen activator. Blood 1989; 73: 1213-1217
  • 10 Prins MH, Hirsh J. Heparin as an adjunctive treatment after thrombolytic therapy for acute myocardial infarction. Am J Cardiol 1991; 67: 3A-11A
  • 11 Agnelli G, Pascucci C, Cosmi B, Nenci GG. Effects of therapeutic doses of heparin on thrombolysis with tissue-type plasminogen activator in rabbits. Blood 1990; 76: 2030-2036
  • 12 Stassen JM, Juhan-Vague I, Aleassi MC, De Cock F, Collen D. Potentiation by heparin fragments of thrombolysis induced with human tisse-type plasminogen activator or human single-chain urokinase-type plasminogen activator. Thromb Haemostas 1987; 58: 947-950
  • 13 Van Ryn-McKenna J, Ofosu FA, Buchanan MR. Dermatan sulfate increases tPA-induced thrombolysis without increasing bleeding in rabbits. Thromb Haemostas 1991; 65: 787 Abst 396
  • 14 Mellott MJ, Connolly TM, York SJ, Bush LR. Prevention of reocclusion by MCI-9038, a thrombin inhibitor, following tPA-induced thrombolysis in a canine model of femoral arterial thrombosis. Thromb Haemostas 1990; 64: 526-534
  • 15 Klement P, Hirsh J, Maraganore J, Weitz J. The effect of thrombin inhibitors on tissue plasminogen activator-induced thrombolysis in a rat model. Thromb Haemostas 1991; 65: 735 Abst 255
  • 16 Kaiser B, Simon A, Markwardt F. Antithrombotic effects of recombinant hirudin in experimental angioplasty and intravascular thrombolysis. Thromb Haemostas 1990; 63: 44-47
  • 17 ISIS-2 (Second International Study of Infarct Survival). Collaborative study group randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,787 cases of suspected acute myocardial infarction: ISIS-2. Lancet 1988; 2: 349-360
  • 18 Gruppo Italiano per lo studio della sopravvitenza nell’infarto miocardico. GISSI-2, a factorial randomised trial of alteplase versus streptokinase and heparin versus no heparin among 12,490 patients with acute myocardial infarction. Lancet 1990; 336: 65-75
  • 19 The SCATI group. Randomized controlled trial of subcutaneous calcium-heparin in acute myocardial infarction. Lancet July 22 1989; 182-186
  • 20 Herbert JM, Bernat A, Barthelemy G, Dol F, Rinaldi M. Antithrombotic activity of SR 46349, a novel, potent and selective 5-HT2 receptor antagonist. Thromb Haemostas 1993; 69: 262-267
  • 21 Rinaldi-Carmona M, Congy C, Santucci V, Simiand J, Gautret BNeliat G, Labeeuw B, Le Fur G, Soubrie P, Breliere JC. Biochemical and pharmacological properties of SR 46349B, a new potent and selective 5-hydroxytryptamine2 receptor antagonist. J Pharmacol Exp Ther 1992; 262: 759-768
  • 22 Born GV. Aggregation of blood platelets by adenosine diphosphate and its reversal. Nature (London) 1962; 194: 927-929
  • 23 Collen D, Stassen JM, Verstraete M. Thrombolysis with human extrinsic (tissue-type) plasminogen activator in rabbits with experimental jugular vein thrombosis. Effect of molecular form and dose of activator, age of the thrombus, and route of administration. J Clin Invest 1983; 71: 368-376
  • 24 Defreyn G, Bernat A, Delebassée D, Maffrand JP. Pharmacology of ticlopidine: a review. Semin Thromb Hemostas 1989; 15: 159-165
  • 25 Chesebro JH, Lam JYT, Badimon L, Fuster V. Restenosis after arterial angioplasty: a hemorrheologic response to injury. Am J Cardiol 1987; 60: 10B-16B
  • 26 Harker LA. Role of platelets and thrombosis in mechanisms of acute occlusion and restenosis after angioplasty. Am J Cardiol 1987; 60: 20B-28B
  • 27 Eisenberg PR, Sherman LA, Jaffe AS. Paradoxic elevation of fibrinopeptide A after streptokinase: evidence for continued thrombosis despite intense fibrinolysis. J Am Coll Cardiol 1987; 10: 527-530
  • 28 Liu CY, Nossel HL, Kaplan KL. The binding of thrombin by fibrin. J Biol Chem 1979; 254: 10421-10425
  • 29 Ross AM, Hsi J, Hamilton W, Chartman B, Roberts R, Kleiman NS. Heparin versus aspirin after recombinant tissue plasminogen activator therapy in acute myocardial infarction: a randomized trial. J Am Coll Cardiol 1990; 15: 64A-76A
  • 30 Hirsh PD, Hillis LD, Campbell WB, Firth BG, Willerson JT. Release of prostaglandins and thromboxane into the coronary circulation in patients with ischemic heart disease. N Engl J Med 1981; 304: 685-691
  • 31 Van den Berg EK, Schmitz JM, Benedict CR, Malloy CR, Willerson JT, Dehmer GJ. Transcardiac serotonin concentration in increased in selected patients with limiting angina and complex coronary lesion morphology. Circulation 1989; 49: 116-124
  • 32 Fitzgerald DJ, Catella F, Roy L, Fitzgerald GA. Marked platelet activation in vivo after intravenous streptokinase in patients with acute myocardial infarction. Circulation 1988; 77: 142-154
  • 33 Nawroth PP, Stern DM. Endothelial cells as active participants in procoagulant reactions. In: Vascular Endothelium in Hemostasis and Thrombosis. Gimbrone GA. (ed) Churchill Livingstone, New York: 1986: 14-39
  • 34 Wagner B, Schneider B, Blöchl-Daum B, Speiser W, Eichler HG, Lechner K, Kyrle PA. Effect of ritanserin, a 5-hydrohytryptamine 2-receptor antagonist, on platelet function and thrombin generation at the site of plug formation in vivo. Clin Pharmacol Ther 1990; 48: 419-423
  • 35 Rao AK, Pratt C, Berke A, Jaffe A, Ockene I, Schreiber TL, Bell WR, Knatterud G, Robertson TL, Terrin ML. Thrombolysis in myocardial infarction (TIMI) trial phase I: hemorrhagic manifestations and changes in plasma fibrinogen and the fibrinolytic system in patients treated with recombinant tissue plasminogen activator and streptokinase. J Am Coll Cardiol 1988; 11: 1-11
  • 36 Califf RM, Topol EJ, George BS, Boswick JM, Sigmon KW, Candela R, Masek R, O’Neill WW, Stack RS, Stumo D. Hemorrhagic complications associated with the use of intravenous tissue plasminogen activator in the treatment of myocardial infarction. Am J Med 1988; 85: 353-359