ACTIVATION OF COAGULATION AND FIBRINOLYSIS DESPITE HEPARINIZATION DURING SUCCESSFUL ELECTIVE CORONARY ANGIOPLASTY

Our aim was to assess whether the vessel wall trauma induced by balloo n inflation during successful elective PTCA results in activation of c oagulation and fibrinolysis detectable in circulating blood. In the pi lot group (10 patients), when blood was collected under heparinization with adequate anti-Factor Xa activity, catheter-induced thrombin gene ration was not detected and results obtained from local coronary arter ial versus systemic samples did not differ. Locally, von Willebrand fa ctor antigen increased from 73.5 +/- 8.8% to 77.8 +/- 13.1% (p<0.05) a t 5 min after PTCA. In the study group with its 21 patients having ade quate heparinization fibrinogen decreased when blood was collected fro m aorta 15 min after PTCA. In 30% of the patients having the largest c alculated area of vessel damage, thrombin-antithrombin III (TAT) compl ex and prothrombin fragments (F1+2) spiked by at least 25% during PTCA . In all patients the mean TAT values did not increase, but F1+2 (from 0.56 +/- 0.36 to 0.63 +/- 0.39 nmol/l, mean +/- SD, p<0.05) and D-dim er (from 268 +/- 37 to 325 +/- 45 ng/ml, p<0.05) rose between 15 to 30 min after PTCA. In conclusion, in every third patient thrombin genera tion occurs after successful elective PTCA, implying a need for a tigh ter control than heparin provides.