Effects Of Antiplatelet Drug Ticlid On The Endogenous Fibrinolytic System In Patients With Acute Coronary Syndrome Undergoing Therapy

BACKGROUD: Acute coronary syndrome (ACS), which includes unstable angina, non-Q-wave myocardial infarction and Q-wave myocardial infarction, is a special group of coronary heart diseases (CHD). It is caused mainly by thrombosis based on coronary atherosclerosis rupture. There is now increasing evidence that coronary thrombosis plays an important role in the production of acute coronary syndrome. The increased tendency to thrombosis can be explained by several mechanisms including an increase hi platelet aggregation, activation of coagulation system, and a defective fibrinolytic system. Antiplatelet treatment can reduce coronary events, which have been demonstrated in many studies.However, alterations of coagulation and fibrinolytic both exist in ACS, so that improving the defective fibrinolytic system may be another therapy method. The reduction of fibrinolytic activity can be caused by either of two major mechanisms - a reduced of t-PA or an increased release of PAL Studies have shown that plasma level of PAI and t-PA mass concentrations are elevated in patients with ACS. Ticlid is specifically developed as an antiplatelet drug and has potent broat-spectrum anti-aggregating activity. Antiplatelet therapy is a logical approach to the prevention of atherothrombotic vascular disease since platelet are involved in both atherosclerosis and thrombosis. In this present study, we examined whether antiplatelet therapy has effect on fibrinolytic system, and compare Aspirin along versus combined Ticlid and Aspirin. MOTHODS: From August 2001 to March 2002,sixty-two patients with ACS are enrolled in the study. All of them had angio graphically significant coronary artery disease (at least one epicardial artery).Sixty-two patients randomly divided into two groups: test-group(n=32) and routine treatment -group(n=30).All patients received treatment that included, if appropriate, intravenous therapy with nitrates, calcium antagonists, and |3 -blockers. RT-group patients received Aspirin (300mg/d), T-group patients received Aspirin (300mg/d) and Ticlid (250mg/d). Plasma GMP-140, t-PA activity, t-PA mass concentrations, PAI-1 activity and D-domain were measured at pre-treatment and post-treatment. And all of these targets were also measured in RT-group before and after CAG. According to coronary stenosis degree by CAG, six-two patients were divided into three groups: mild, moderate and severe groups. All of GMP-140, t-PA activity, t-PA mass concentrations, PAI-1 activity and D-domain were measured. There were twenty health controlsRESULTS: CD In ACS at pre-treatment,GMP-140,t-PA MQPAI-1 and D-domain are higher than health control group, but t-PA activity lower(P<0.01). (D After 1 week therapy, both in RT-group and T-group t-PA activity is significantly higher than pre-treatment, but GMP-140,t-PA MC,PAI-1 and D-domain lower(P<0.01). (D After treatment, there is significant difference between RT-group and T-group with GMP-140,t-PA activity,PAI-l activity. After treatment, GMP-140 and PAI-1 in T-group is lower and t-PA activity is higher (P<0.01). 〢fter treatment, except t-PA activity, all targets in ACS are still significantly different from health control group. ㏕here is no significant difference between before and after CAG in RT-group. ㏕here is no difference between mild, moderate and severe groups.CONCLUSION: (1)ACS patients have defection of endogenous fibrinolytic system. (2) Antiplatelet drug Ticlid can improve endogenous fibrinolytic system activity. (3)Combined Ticlid and Aspirin therapy are shown to be more effective on antiplatelet and improving endogenous fibrinolytic system than Aspirin along. (4)Coronary angiograph is a highly safe interventional diagnosis technique, which has no adverse of platelet activation. ㏒everity of defective fibrinolytic system has no relationship with coronary stenosis degree.