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Circulation, Vol 77, 142-150, Copyright © 1988 by American Heart Association
DJ Fitzgerald, F Catella, L Roy and GA FitzGerald
We assessed thromboxane biosynthesis as an index of platelet activation in
6 patients with acute myocardial infarction receiving intravenous
streptokinase. Urinary 2,3-dinor-thromboxane B2 and plasma 11-dehydro-
thromboxane B2, major enzymatic metabolites of thromboxane A2, were
markedly increased after intravenous streptokinase (11,063 +/- 2758 pg/mg
creatinine and 33 +/- 10 pg/ml, respectively) compared with levels in
patients not receiving thrombolytic therapy (502 +/- 89 pg/mg creatinine
and 3 +/- 0.7 pg/ml). Prostacyclin biosynthesis also increased markedly
after streptokinase coincident with the increase in thromboxane A2
formation. Administration of aspirin between the time of onset of coronary
thrombosis and reperfusion both in man and in a canine preparation
demonstrated that this reflected thromboxane biosynthesis de novo and not
metabolism of preformed inactive thromboxane B2 washed out from the
coronary circulation. Since the platelet is the major source of thromboxane
A2, these findings suggest that there is marked platelet activation after
coronary thrombolysis with streptokinase. Studies in vitro demonstrated
that streptokinase enhanced platelet activation in a dose-dependent manner,
resulting in the secondary release of thromboxane A2. The increase in
platelet activation and thromboxane A2 biosynthesis may limit the
therapeutic effect of intravenous streptokinase in acute myocardial
infarction.
ARTICLES
Marked platelet activation in vivo after intravenous streptokinase in patients with acute myocardial infarction
Divisions of Clinical Pharmacology, Vanderbilt University, Nashville, TN 37232.
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