Effect of activated protein C on plasma plasminogen activator inhibitor activity in patients with acute myocardial infarction treated with alteplase - Comparison with unfractionated heparin
Effect of activated protein C on plasma plasminogen activator inhibitor activity in patients with acute myocardial infarction treated with alteplase - Comparison with unfractionated heparin
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DOI：
10.1016/s0735-1097(03)01059-3
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发表时间：
2003-10-15
影响因子：
24
通讯作者：
Okajima, K
中科院分区：
文献类型：
--
作者：
Sakamoto, T;Ogawa, H;Okajima, K
目的：我们研究活化蛋白C （APC）是否是st段抬高的急性心肌梗死（AMI）患者溶栓的有效联合治疗。活化蛋白C具有全身抗凝血和抗炎特性。它也被证明通过抑制纤溶酶原激活物抑制剂（PAI）活性来增强纤维蛋白溶解。方法：在阿替普酶溶栓成功后，研究患者被分配接受两种联合治疗中的一种，静脉注射48小时：人血浆源性APC， 0.06 mg/kg /天（APC组，n = 9），或未分离肝素，100至400 U/kg /天，调整至维持激活的部分凝血活素时间为对照水平的1.5至2倍（肝素组，n = 10）。结果：肝素组（10例中有4例）的不良事件发生率高于APC组（9例中无一例）（p = 0.033），包括再通梗死相关冠状动脉再闭塞和大出血并发症。肝素组溶栓后8 ~ 24 h血浆PAI活性（IU/ml，中位数[范围]）持续升高，24 h达到峰值（30.9 [11.3 ~ 38.5]）；而APC组溶栓后24 h无升高（11.3[0.0 ~ 31.0]，与肝素组比较p < 0.01）。结论APC可抑制AMI患者溶栓后血浆PAI活性的升高。与肝素相比，APC作为AMI患者溶栓的联合治疗方案可能更符合条件。(C) 2003年由美国心脏病学会基金会发布。
OBJECTIVES We examined whether activated protein C (APC) is an effective conjunctive therapy to thrombolysis in patients with ST-segment-elevated acute myocardial infarction (AMI).BACKGROUND Activated protein C possesses both systemic anticoagulant and anti-inflammatory properties. It has been also shown to enhance fibrinolysis by inhibiting plasminogen activator inhibitor (PAI) activity in vitro.METHODS After successful thrombolysis with alteplase, study patients were assigned to receive one of the two conjunctive therapies for 48 h intravenously: human plasma-derived APC at 0.06 mg/kg per day (APC group, n = 9) or unfractionated heparin at 100 to 400 U/kg per day, adjusted to maintain an activated partial thromboplastin time at 1.5 to 2 times of the control level (heparin group, n = 10).RESULTS Adverse events, including reocclusion of the recanalized infarct-related coronary artery and major or minor hemorrhagic complications, occurred more frequently in the heparin group (4 of 10 cases) than in the APC group (none of 9 cases) (p = 0.033). In the heparin group, plasma PAI activity (IU/ml, median value [range]) was increased continuously from 8 to 24 h after thrombolysis and peaked at 24 h (30.9 [11.3 to 38.5]); on the other hand, it was not increased in the APC group at 24 h after thrombolysis (11.3 [0.0 to 31.0], p < 0.01 vs. heparin group).CONCLUSIONS Administration of APC suppressed increasing of plasma PAI activity observed after thrombolysis in patients with AMI. The effect of APC could be more eligible, compared with heparin, as a conjunctive regimen to thrombolysis in AMI patients. (C) 2003 by the American College of Cardiology Foundation.