Thrombin-antithrombin III complex levels > 6 ng/l at 120 minutes into thrombolysis predicted an unfavorable clinical course with 96.2% sensitivity and 93.1% specificity.
Cohort (n=55)
Do thrombin-antithrombin III complex levels predict the success of thrombolytic therapy in patients with acute myocardial infarction?
Thrombin generation during thrombolysis is a major determinant of therapy success, and thrombin-antithrombin III levels can accurately predict short-term angiographic outcomes in acute myocardial infarction.
Effect estimate: 96.2% sensitivity and 93.1% specificity
BACKGROUND: It has been suggested that thrombolysis in a feedback reaction may generate pro-coagulant activities. METHODS AND RESULTS: Fifty-five patients were treated with urokinase-preactivated prourokinase (n = 35) or tissue-type plasminogen activator (n = 20) for acute myocardial infarction and underwent coronary angiography at 90 minutes and at 24-36 hours into thrombolysis, and fibrinogen (Ratnoff-Menzie), D-dimer (ELISA) and thrombin-antithrombin III complex levels (ELISA) were measured. Primary patency was achieved in 39 patients (70.9%), 13 of whom (33.3%) suffered early reocclusion. Nonsignificant decreases in fibrinogen levels were observed while D-dimer levels increased +3,008 +/- 4,047 micrograms/l (p less than 0.01), differences not being significant in respect to the thrombolytic agents or to the clinical course. In contrast, while thrombin-antithrombin III complex levels decreased -4.4 +/- 13.0 micrograms/l in patients with persistent patency, they increased +7.5 +/- 13.6 micrograms/l in case of nonsuccessful thrombolysis (p less than 0.02) and +11.9 +/- 23.8 micrograms/l in case of early reocclusion (p less than 0.001). For patients with thrombin-antithrombin III complex levels greater than 6 ng/l 120 minutes into thrombolysis, the unfavorable clinical course was predicted with 96.2% sensitivity and 93.1% specificity. CONCLUSION: Generation of thrombin, occurring during thrombolysis, is a major determinant for the success of therapy and thrombin-antithrombin III levels may serve as predictors for the short-term prognosis.
Gulba et al. (Fri,) conducted a cohort in acute myocardial infarction (n=55). Thrombin generation (thrombin-antithrombin III complex levels > 6 ng/l) vs. Thrombin-antithrombin III complex levels ≤ 6 ng/l was evaluated on Unfavorable clinical course (nonsuccessful thrombolysis or early reocclusion) (96.2% sensitivity and 93.1% specificity). Thrombin-antithrombin III complex levels > 6 ng/l at 120 minutes into thrombolysis predicted an unfavorable clinical course with 96.2% sensitivity and 93.1% specificity.