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Temporal relation between ischemic episodes and activation of the coagulation system in unstable angina.

Abstract：

BACKGROUND:Although a major role of coronary thrombosis in the pathogenesis of unstable angina has been demonstrated, the results of a series of studies have suggested that activation of the hemostatic system may not be confined to ischemic episodes. The purpose of this study was to investigate the temporal relation between ischemic episodes and activation of the coagulation system in unstable angina. METHODS AND RESULTS:Thrombin-antithrombin III (TAT) and prothrombin fragment 1 + 2 (F1 + 2) levels were measured in 13 patients during spontaneous ischemic episodes (time 0, 5, and 15 minutes and 1 hour) to evaluate the time course of the activation of the coagulation system associated with the development of ischemia (protocol A). TAT and F1 + 2 levels were also measured in 28 patients with unstable angina on admission to hospital (every 6 hours for 24 hours and daily for 3 days) to assess their temporal relation with ischemic episodes (protocol B). In protocol A, TAT and F1 + 2 levels were elevated in 10 of 13 patients (77%) in at least 1 sample. The median value of TAT showed a peak at 5 minutes and returned to baseline within 15 minutes (P < .05), consistent with its plasma half-life of 5 minutes, whereas the median value of F1 + 2 showed no significant changes, possibly because of its longer half-life, which tends to dampen sudden bursts of thrombin production. In protocol B, activation of the clotting system was found in 10 of 33 samples (30%) temporally related to ischemia and also in 23 of 150 (15%, P = .07) of those not temporally related to ischemia. CONCLUSIONS:Our study demonstrates that patients with active unstable angina develop frequent bursts of thrombin production not necessarily associated with ischemic episodes and that, conversely, some ischemic episodes are not associated with evidence of thrombin activation.

journal_name

Circulation

journal_title

Circulation

authors

Biasucci LM,Liuzzo G,Caligiuri G,Quaranta G,Andreotti F,Sperti G,van de Greef W,Rebuzzi AG,Kluft C,Maseri A

doi

10.1161/01.cir.93.12.2121

subject

Has Abstract

pub_date

1996-06-15 00:00:00

pages

2121-7

issue

eissn

0009-7322

issn

1524-4539

journal_volume

pub_type

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Temporal relation between ischemic episodes and activation of the coagulation system in unstable angina.