PATTERNS OF COAGULOGIC PARAMETERS IN PATI ENTS WITH MYOCARDIAL-INFARCTION AND EARLY SPONTANEOUS OR MEDICAL CORONARY REPERFUSION

To elucidate the role of the state of coagulation-fibrinolysis system for early spontaneous thrombolysis and for efficacy of thrombolytic th erapy 163 patients admitted within first 6 hours of myocardial infarct ion were evaluated. Thombolytic therapy was employed in 140 patients. In 24 patients blood flow through infarct related artery was observed without thrombolytic drugs or before their Infusion (group 1); In 68 p atients reperfusion was achieved within 6 hours after thrombolytics (g roup 2) end In 71 patients (group 3) occlusion persisted. Comparison o f initial data revealed the following differences between groups. In g roup 1 trombin time was significantly higher than In group 2, end part ial activated thromboplastin time, prothrombin and thrombin times were higher than In group 3; In group 3 initial activity of plasminogen ac tivator inhibitor and plasminogen level were higher than in groups 2 a nd 1. after infusion of a thrombolytic drug protein C level In group 1 was lower than in two other groups (104.1+/-6.2%; 122.8+/-5.1%; 127.8 +/-5.1%, p<0.05, and 104.0+/-5.5%; 129.8+/-4.7%; 120.8+/-4.5%, p<0.05, in groups 1,2,3, in 6 end 9 hours after thrombolytic therapy, respect ively). Early restoration of blood flow was linked with more active fi brinolysis. In patients with no signs of coronary reperfusion during f irst 6 hours of myocardial infarction insufficient fibrinolysis was ma nifested by augmented activity of tissue type plasminigen activator in hibitor and as a consequence by higher plasminogen level (because of i ts decreased consumption). Increased activity of anticoagulation syste m in patients with spontaneous reperfuson (group 1) evidenced by highe r protein C consumption led probably to formation of less stable throm bus which could be more easily lysed by endoge-nous fibrinolysis.