Paradoxic elevation of fibrinopeptide A after streptokinase: evidence for continued thrombosis despite intense fibrinolysis.
Paradoxic elevation of fibrinopeptide A after streptokinase: evidence for continued thrombosis despite intense fibrinolysis.
复制标题
链激酶后纤维蛋白肽 A 反常升高：尽管有强烈的纤维蛋白溶解，但血栓持续形成的证据。
DOI：
10.1016/s0735-1097(87)80194-8
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发表时间：
1987
影响因子：
24
通讯作者：
Jaffe,AS
中科院分区：
文献类型：
--
作者：
Eisenberg,PR;Sherman,LA;Jaffe,AS
纤维蛋白肽A（与急性心肌梗死相关的凝血酶活性的标志物）水平升高，已发现在再灌注发生时链激酶给药后降低。相反，在没有再灌注的患者和链激酶治疗后再闭塞的患者中，纤维蛋白肽A仍然升高。在本研究中，早期连续测定纤维蛋白肽A，以进一步表征链激酶后凝血酶活性的反常增加，并表征其对肝素的反应，在19例急性心肌梗死患者中，治疗前纤维蛋白肽A升高至82.3 ± 43.5ng/ml（平均值±标准误）。在链激酶启动后30分钟，纤维蛋白肽A增加到300.1 ± 117.4 ng/ml（p < 0.01），与广泛的凝血酶活性一致。纤维蛋白肽A持续升高，直至肝素推注后15分钟，此时水平降至链激酶后值的15%（49.2 ± 13.3 ng/ml）（p < 0.001）。这些数据证明了链激酶给药后凝血酶活性的迅速反常增加，这可能是某些患者治疗失败的原因。
Elevated levels of fibrinopeptide A, a marker of thrombin activity associated with acute myocardial infarction, have been found to decrease after administration of streptokinase when reperfusion occurs. In contrast, in patients without reperfusion and those with reocclusion after streptokinase therapy, fibrinopeptide A remains elevated. In the present study early serial measurements of fibrinopeptide A were used to further characterize this paradoxic increase in thrombin activity after streptokinase and to characterize its response to heparin.In 19 patients with acute myocardial infarction fibrinopeptide A was elevated to 82.3 ± 43.5 ng/ml (mean ± SE) before therapy. Thirty minutes after the initiation of streptokinase, fibrinopeptide A increased to 300.1 ± 117.4 ng/ml (p < 0.01), consistent with extensive thrombin activity. Fibrinopeptide A remained elevated until 15 minutes after a heparin bolus injection when levels decreased to 15% of the postStreptokinase value (49.2 ± 13.3 ng/ml) (p < 0.001). These data document a prompt paradoxic increase in thrombin activity after administration of streptokinase that may be responsible for failure of therapy in some patients.