SERIAL THROMBOLYSIS-RELATED CHANGES AFTER THROMBOLYTIC THERAPY WITH TPA IN PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION
SERIAL THROMBOLYSIS-RELATED CHANGES AFTER THROMBOLYTIC THERAPY WITH TPA IN PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION
复制标题
急性心肌梗塞患者接受 TPA 溶栓治疗后与溶栓相关的系列变化
DOI：
10.1016/0049-3848(90)90102-i
复制
发表时间：
1990-05-01
影响因子：
7.5
通讯作者：
WANG, SP
中科院分区：
文献类型：
--
作者：
HO, CH;WANG, SP
29例急性心肌梗死患者在胸痛发作后6 h内（平均3.2h）给予重组组织型纤溶酶原激活剂（tPA）100 mg静脉滴注，3 h内完成溶栓治疗。总FDP、FDP D-二聚体的系列测定分别于术前、术后1、2、4、6、12、24、26、28、29、在29例患者开始tPA注射后48小时，以评估溶栓治疗后的止血变化。纤溶酶原、Fg、AAP和ELT从治疗后1小时开始下降，分别持续至24、12、24和12小时，最大降幅通常在1-4小时之间，FDP、FDP D-二聚体、PT、APTT和RT分别从治疗后1、1、2、1和1小时开始升高，分别持续至24、12、12、24和12小时，在48小时研究期间，未观察到ATIII的显著变化。4例（13.79%）出现局部出血，1例需输注1单位浓缩红细胞。所有溶栓相关变化均在tPA治疗后24小时内恢复。到目前为止，我们研究的参数都不能用于预测tPA治疗后冠状动脉通畅的可能性。但发现FDP显著升高与出血并发症的高风险相关。由于凝血变化持续24小时或更长时间，因此在接受tPA治疗的患者中，有必要仔细监测凝血试验并密切观察临床出血体征长达48小时。
Twenty-nine patients with acute myocardial infarction were given recombinant tissue plasminogen activator (tPA) within 6 hr after onset of chest pain (mean: 3.2 hr) with a total dose of 100mg iv drip given within 3hr for thrombolytic therapy. Serial determinations of total FDP, FDP D-Dimer (specific for FbDP), fibrinogen (Fg), PT, APTT, reptilase time (RT), plasminogen, alpha2-antiplasmin (AAP), euglobulin lysis time (ELT) and antithrombin III (ATIII) were performed before and 1, 2, 4, 6, 12, 24, 48 hr after initiation of tPA injection in the 29 patients in order to evaluate the hemostatic changes after thrombolytic therapy. Decreases of plasminogen, Fg, AAP and ELT were found from 1 hr after therapy and persisted to 24, 12, 24 and 12 hr, respectively, with the maximum decrease usually between 1-4 hr. Increases of FDP, FDP D-dimer, PT, APTT and RT were found from 1, 1, 2, 1 and 1 hr after therapy, respectively, and sustained to 24, 12, 12, 24 and 12 hr, respectively, with maximum increases between 1-4 hr. No significant changes of ATIII were noted during the 48-hr study-period. 4 of these 29 patients (13.79%) had the complication of localized bleeding, 1 of them needed 1 unit of packed red blood cell transfusion. All thrombolysis-related changes recovered within 24 hr after tPA therapy. No parameter we have studied so far could be used for the prediction of the possibility of coronary patency after tPA therapy. But markedly elevated FDP was found to be associated with high risk of bleeding complication. As the coagulation changes persist for 24 hr or longer, careful monitoring of the coagulation tests and close observation of clinical bleeding signs up to 48 hr are necessary in patients treated with tPA.