Xue-qin Jia1, Chen-ming Dong, Jing Qin, Ling Zhang. 1. Department of Emergency, the Second Hospital of Lanzhou University, Lanzhou 730030, Gansu, China. jiaxueqin656422@163.com
Abstract
OBJECTIVE: To investigate the changes in coagulation and fibrinolysis parameters during acute phase of coronary heart disease, and to explore the effects of drug intervention in same period. METHODS: A prospective study was conducted. The changes in plasma von Willebrand factor (vWF), platelet activating factor (PAF), tissue type plasminogen activator (t-PA) of 110 patients with coronary heart disease [50 patients with acute myocardial infarction (AMI), 35 patients with unstable angina pectoris (UAP), 25 patients with ischemic cardiomyopathy (ICM)] were determined immediately at admission and 14 days after treatment. The indexes of 19 healthy individuals were collected as control. At the same time, randomized and double-blind observation of the changes in plasma coagulation and fibrinolysis system indexes including vWF, PAF and t-PA was made in AMI and UAP patients who received conventional treatment (aspirin + low molecular weight heparin) or combination of conventional treatment and clopidogrel for 14 days. RESULTS: The vWF and PAF levels (nmol/L) of AMI and UAP patients at admission were significantly higher than those in healthy control group [vWF: (202.31 ± 27.38)%, (188.65 ± 31.08)% vs. (120.37 ± 18.79)%; PAF: 50.64 ± 13.25, 48.87 ± 13.24 vs. 15.43 ± 9.27, all P < 0.05], however, t-PA (μg/L) was remarkably lower than that in healthy control group (3.52 ± 1.57, 4.03 ± 2.04 vs. 9.54 ± 1.32, both P < 0.01). After 14 days of treatment, the levels of vWF, PAF, t-PA, fibrinogen (Fib, g/L), D-dimer (mg/L) in plasma of AMI and UAP patients were close to those of healthy control group [vWF: (116.56 ± 26.10)%, (111.28 ± 22.31)% vs. (120.37 ± 18.79)%; PAF: 17.48 ± 9.16, 16.23 ± 9.17 vs. 15.43 ± 9.27; t-PA: 7.91 ± 2.42, 9.01 ± 2.01 vs. 9.54 ± 1.32; Fib: 3.64 ± 0.53, 2.74 ± 0.72 vs. 2.92 ± 0.91; D-dimer: 0.370 ± 0.150, 0.288 ± 0.169 vs. 0.255 ± 0.109, all P>0.05]. However, there was no statistical difference in vWF, PAF, t-PA, Fib and D-dimer levels before and after treatment in ICM group compared with healthy control group [vWF: (124.14 ± 21.17)%, (119.44 ± 26.28)% vs. (120.37 ± 18.79)%; PAF: 15.69 ± 7.14, 14.84 ± 9.16 vs. 15.43 ± 9.27; t-PA: 8.62 ± 2.24, 8.07 ± 2.51 vs. 9.54 ± 1.32; Fib: 3.24 ± 0.74, 3.04 ± 0.77 vs. 2.92 ± 0.91; D-dimer: 0.257 ± 0.132, 0.268 ± 0.117 vs. 0.255 ± 0.109, all P>0.05]. Multiple linear regression analysis showed that, in patients with coronary heart disease, PAF be positively correlated with vWF (r = 0.42, P < 0.01), but negatively correlated with t-PA (r = -0.31, P < 0.01). In patients with AMI and UAP, using the treatment of clopidogrel for 14 days, the levels of vWF, PAF, t-PA, Fib and D-dimer in plasma showed no significant differences compared with those of conventional treatment group [vWF: (120.16 ± 16.57)% vs. (118.12 ± 14.32)%; PAF: 12.01 ± 3.70 vs. 13.33 ± 1.10; t-PA: 9.75 ± 1.60 vs. 7.59 ± 2.46; Fib: 2.73 ± 0.49 vs. 3.09 ± 0.50; D-dimer: 0.233 ± 0.101 vs. 0.252 ± 0.088, all P>0.05]. CONCLUSIONS: There were changes in coagulation and fibrinolysis status in patients with AMI and UAP at the initial stage, the level of t-PA was decreased significantly. For patients with AMI and UAP, there were no obvious differences in coagulation and fibrinolysis parameters between combination therapy of clopidogrel and aspirin and aspirin alone.
RCT Entities:
OBJECTIVE: To investigate the changes in coagulation and fibrinolysis parameters during acute phase of coronary heart disease, and to explore the effects of drug intervention in same period. METHODS: A prospective study was conducted. The changes in plasma von Willebrand factor (vWF), platelet activating factor (PAF), tissue type plasminogen activator (t-PA) of 110 patients with coronary heart disease [50 patients with acute myocardial infarction (AMI), 35 patients with unstable angina pectoris (UAP), 25 patients with ischemic cardiomyopathy (ICM)] were determined immediately at admission and 14 days after treatment. The indexes of 19 healthy individuals were collected as control. At the same time, randomized and double-blind observation of the changes in plasma coagulation and fibrinolysis system indexes including vWF, PAF and t-PA was made in AMI and UAP patients who received conventional treatment (aspirin + low molecular weight heparin) or combination of conventional treatment and clopidogrel for 14 days. RESULTS: The vWF and PAF levels (nmol/L) of AMI and UAP patients at admission were significantly higher than those in healthy control group [vWF: (202.31 ± 27.38)%, (188.65 ± 31.08)% vs. (120.37 ± 18.79)%; PAF: 50.64 ± 13.25, 48.87 ± 13.24 vs. 15.43 ± 9.27, all P < 0.05], however, t-PA (μg/L) was remarkably lower than that in healthy control group (3.52 ± 1.57, 4.03 ± 2.04 vs. 9.54 ± 1.32, both P < 0.01). After 14 days of treatment, the levels of vWF, PAF, t-PA, fibrinogen (Fib, g/L), D-dimer (mg/L) in plasma of AMI and UAP patients were close to those of healthy control group [vWF: (116.56 ± 26.10)%, (111.28 ± 22.31)% vs. (120.37 ± 18.79)%; PAF: 17.48 ± 9.16, 16.23 ± 9.17 vs. 15.43 ± 9.27; t-PA: 7.91 ± 2.42, 9.01 ± 2.01 vs. 9.54 ± 1.32; Fib: 3.64 ± 0.53, 2.74 ± 0.72 vs. 2.92 ± 0.91; D-dimer: 0.370 ± 0.150, 0.288 ± 0.169 vs. 0.255 ± 0.109, all P>0.05]. However, there was no statistical difference in vWF, PAF, t-PA, Fib and D-dimer levels before and after treatment in ICM group compared with healthy control group [vWF: (124.14 ± 21.17)%, (119.44 ± 26.28)% vs. (120.37 ± 18.79)%; PAF: 15.69 ± 7.14, 14.84 ± 9.16 vs. 15.43 ± 9.27; t-PA: 8.62 ± 2.24, 8.07 ± 2.51 vs. 9.54 ± 1.32; Fib: 3.24 ± 0.74, 3.04 ± 0.77 vs. 2.92 ± 0.91; D-dimer: 0.257 ± 0.132, 0.268 ± 0.117 vs. 0.255 ± 0.109, all P>0.05]. Multiple linear regression analysis showed that, in patients with coronary heart disease, PAF be positively correlated with vWF (r = 0.42, P < 0.01), but negatively correlated with t-PA (r = -0.31, P < 0.01). In patients with AMI and UAP, using the treatment of clopidogrel for 14 days, the levels of vWF, PAF, t-PA, Fib and D-dimer in plasma showed no significant differences compared with those of conventional treatment group [vWF: (120.16 ± 16.57)% vs. (118.12 ± 14.32)%; PAF: 12.01 ± 3.70 vs. 13.33 ± 1.10; t-PA: 9.75 ± 1.60 vs. 7.59 ± 2.46; Fib: 2.73 ± 0.49 vs. 3.09 ± 0.50; D-dimer: 0.233 ± 0.101 vs. 0.252 ± 0.088, all P>0.05]. CONCLUSIONS: There were changes in coagulation and fibrinolysis status in patients with AMI and UAP at the initial stage, the level of t-PA was decreased significantly. For patients with AMI and UAP, there were no obvious differences in coagulation and fibrinolysis parameters between combination therapy of clopidogrel and aspirin and aspirin alone.