V.Netyazhenko, T.Malchevska, A.Kudlay, O.Lykov, National Medical University ,
Kiev-Ukraine
Haemostatic potentials in patients with acute myocardial infarction treated with thrombolytics

Background: The “Achilles' heel” of systemic thrombolysis are rethrombosis and reoclusion. That is why we consider that determing of coagulation and fibrinolysis parameters is important. Group of patients (pts) (30 males) with acute myocardial infarction (Q-AMI) were included into the study. The age of pts ranged from 50 to 70 years. Anterior localization of AMI (infarction of anterior wall and ventricular septum of the left ventricular) had 16 pts ; infarction of the posterior wall- 13 pts and in one case the damage was circulatory. AMI on the background of essential hypertension (EH) was observed in 14 pts . Diabetes mellitus was found in 3 cases and glucose abnormalities in 7 pts (only in admission). AMI was complicated in 11 pts . Among the complications there were: cardiac rhythm disturbances (11), acute left ventricular failure (8), reoccurring course of AMI (4), acute aneurism (5). Treatment of all pts was initiated with intravenous streptodekase 3 mln units and 20000 IU of heparin, taking into consideration haemostatic picture of blood. 40,3 % pts had clinical and biochemical signs of successfull thrombolysis. The control group consisted of 30 volunteers.
Methods: Blood from healthy persons and pts was collected by venepuncture into 1/10 volume of 3,8% sodium citrate. After centrifugation at 3500 rpm for 20 minutes, platelet poor plasma was removed and stored at 20°C unit use. All measurements were made within first hours after admission to ICU, 24 h after admission and 10 days after the first blood sampling.. We evaluated the coagulative and fibrinolytic links of haemostasis by standart methods such as: fibrinogen (F), soluble complexes of fibrin monomers (FMSC), fibrinogen degradation products (FDP), euglobulin lysis time (ELT), Hageman dependent fibrinolysis (HDF), plasminogen (P), a 1 -antitrypsin, a 2 -macroglobulin (a 2 -MG). The 6 parameter of haemostasis such as: rate of coagulation (tg a), coagulation time (t 1 ), F, fibrin halflysis (t 1/2 ) and lysis (t 2 ), fibrinolysis rate (tg ß) we estimated in 0,1 ml of blood plasma for 5-10 min by turbidimetric express micromethod. We determined activation of coagulation system and sharp depression of fibrinolysis in all pts at the first hours AMI. It was supported by high levels of F, FDP, P. The t 1/2 , t 2 were prolonged, FMSC, a 2 -MG, tg ß were reduced. The second investigation registered that F, P, ELT, HDF were diminished if compare with first investigation. a 2 -MG , tg ß was not changed, t 1/2 , t 2 were prolonged. 10 days after we determined reccuring depression of fibrinolytic activity (ELT, HDF) that revealed in excess increasing FMSC; FDP, P increased a lot, a 2 -MG , tg ß were reduced.
Conclusion: Thus, we may, conclude that laboratory control is very necessary, when we using the thrombolytic therapy (TT). The reccuring depression of fibrinolytic activity and hypercoagulobility of plasma haemostasis in pts with Q-AMI on 10 day after using TT we can take into account for correcting treatment of these pts and for profilaxis of rethrombosis and reoclusion. On our mind, the using of the standart method is useful when it is necessary to provide the control for the treatment of acute coronary syndrome. This helps to explore the answer of the haemostatic system on the standart treatment, to optimise the laboratory controls and corrigate the haemostatic changes.