Pharmacodynamics of thrombolysis with recombinant tissue-type plasminogen activator. Correlation with characteristics of and clinical outcomes in patients with acute myocardial infarction. The TAMI Study Group.
Pharmacodynamics of thrombolysis with recombinant tissue-type plasminogen activator. Correlation with characteristics of and clinical outcomes in patients with acute myocardial infarction. The TAMI Study Group.
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重组组织型纤溶酶原激活剂溶栓的药效学。
DOI：
10.1161/01.cir.80.5.1222
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发表时间：
1989
期刊：
影响因子：
37.8
通讯作者：
Collen,D
中科院分区：
文献类型：
--
作者：
Stump,DC;Califf,RM;Topol,EJ;Sigmon,K;Thornton,D;Masek,R;Anderson,L;Collen,D
对386例急性心肌梗死患者连续静脉输注重组组织型纤溶酶原激活剂（rt-PA） 150 mg前、中、后采集的血液进行凝血分析。血浆rt-PA升高至峰值水平2.1 +/- 3.1微克/毫升（平均+/- SD）。凝血率测定的纤维蛋白原水平和亚硫酸盐沉淀测定的纤维蛋白原水平分别从基线水平3.0 +/- 0.9和3.2 +/- 1.0 g/l下降到最低点水平1.4 +/- 0.75和1.8 +/- 0.92 g/l，并与血清纤维蛋白原降解产物（FDP）的峰值水平230 +/- 470微克/ml相关。40%的患者的最低功能纤维蛋白原水平低于1.0 g/l，而20%的患者低于0.5 g/l。最低纤维蛋白原水平与梗死相关冠状动脉90分钟内的通畅或7-10天内冠状动脉再闭塞的风险无关。然而，冠状动脉再闭塞的风险与基线功能纤维蛋白原水平呈负相关（p = 0.0008），其降至最低点水平（p = 0.0003）和FDP降至峰值水平（p = 0.038）。定量失血量与全身纤维蛋白原溶解的所有标志物相关，包括纤维蛋白原最低点水平（r = -0.20, p = 0.0011）、纤维蛋白原下降百分比（r = 0.22, p = 0.001）和FDP峰值水平（r = 0.14, p = 0.020）。两例颅内出血患者均表现为高基线纤维蛋白原水平和可凝固纤维蛋白原的广泛降解。总的来说，全身性纤维蛋白原溶解风险最大的患者往往是体重较低的老年妇女。（摘要删节250字）
Coagulation analysis was performed on blood samples from 386 patients with acute myocardial infarction drawn before, during, and after a continuous intravenous infusion of 150 mg recombinant tissue-type plasminogen activator (rt-PA) (Activase). Plasma rt-PA rose to peak levels of 2.1 +/- 3.1 micrograms/ml (mean +/- SD). Fibrinogen levels measured by coagulation rate and by sulfite precipitation decreased from baseline levels of 3.0 +/- 0.9 and 3.2 +/- 1.0 g/l, respectively, to nadir levels of 1.4 +/- 0.75 and 1.8 +/- 0.92 g/l, respectively, and were associated with peak levels in serum of fibrinogen-degradation products (FDP) of 230 +/- 470 micrograms/ml. Forty percent of patients experienced a nadir functional-fibrinogen level of less than 1.0 g/l, whereas 20% fell below 0.5 g/l. Nadir fibrinogen levels did not correlate with patency of the infarct-related coronary artery at 90 minutes or with risk of coronary vessel reocclusion within 7-10 days. However, the risk of coronary artery reocclusion was inversely related to the baseline functional fibrinogen level (p = 0.0008), with the magnitude of its drop to nadir level (p = 0.0003) as well as to peak levels of FDP (p = 0.038). Quantitative blood loss correlated with all markers for systemic fibrinogenolysis including nadir fibrinogen level (r = -0.20, p = 0.0011), percent decrease of fibrinogen (r = 0.22, p = 0.001), and peak FDP levels (r = 0.14, p = 0.020). Both patients who experienced intracranial hemorrhage presented with high baseline fibrinogen levels and experienced extensive degradation of coagulable fibrinogen. Overall, patients at greatest risk of systemic fibrinogenolysis tended to be relatively older women with lower body weight.(ABSTRACT TRUNCATED AT 250 WORDS)