March 1, 1991Circulation
Relative efficacy of antithrombin compared with antiplatelet agents in accelerating coronary thrombolysis and preventing early reocclusion.
Why the study?
Does adjunctive treatment with antithrombin or antiplatelet agents accelerate coronary thrombolysis and prevent early reocclusion in a canine model of coronary thrombosis treated with t-PA?
Population
Conscious dogs with coronary thrombosis induced by electrical current
Comparison
Adjunctive treatment with antiplatelet agents or… vs Saline control given concomitantly with…
Design
Preclinical
Follow-up
90 minutes after the end of t-PA infusion
Authors
Discussion
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Member takes
Implication
May guide adjunctive antithrombin choice in thrombolysis models; leaves open translation to human coronary thrombosis.
Key Points
- To evaluate whether direct thrombin inhibition or platelet inhibition more effectively accelerates t-PA-induced coronary thrombolysis and prevents acute coronary reocclusion.
- Conscious dogs with electrically induced coronary thrombosis received intravenous tissue-type plasminogen activator (t-PA) alongside adjunctive therapy.
- Interventions compared platelet inhibitors (lysine acetylsalicylic acid [ASA] or a glycoprotein IIb/IIIa receptor antagonist) against thrombin inhibitors (recombinant hirudin or heparin adjusted to prolong partial thromboplastin time 1.5- to 2-fold) and saline control.
- Recombinant hirudin accelerated coronary lysis time to 19 ± 10 minutes (versus 43 ± 16 minutes with saline) and completely prevented reocclusion (0 of 6 dogs, 0%), whereas heparin failed to accelerate lysis and resulted in reocclusion in 5 of 6 dogs (83.3%).
- Lysine ASA accelerated lysis to 20 ± 13 minutes, while glycoprotein IIb/IIIa antagonism did not (36 ± 15 minutes); however, reocclusion occurred in 42% of antiplatelet-treated animals (3 of 6 with ASA and 2 of 6 with receptor antagonist) compared to 100% (7 of 7) with saline.
Structured PICO
Does adjunctive treatment with antithrombin or antiplatelet agents accelerate coronary thrombolysis and prevent early reocclusion in a canine model of coronary thrombosis treated with t-PA?
P
Population
Conscious dogs with coronary thrombosis induced by electrical current
I
Intervention
Adjunctive treatment with antiplatelet agents (glycoprotein IIb/IIIa receptor antagonist or lysine acetylsalicylic acid [ASA]) or antithrombin agents (recombinant hirudin or heparin) given concomitantly with intravenous tissue-type plasminogen activator (t-PA)
C
Comparator
Saline control given concomitantly with intravenous t-PA
O
Outcome
Time to thrombolysis and incidence of early coronary reocclusionsurrogate
In a canine model of coronary thrombosis, direct thrombin inhibition with recombinant hirudin was superior to heparin and antiplatelet agents in accelerating t-PA-mediated thrombolysis and preventing early reocclusion.
Cite This Study
Haskel et al. (1991) studied this question.