TIME SIGNIFICANCE OF ACUTE THROMBOTIC REACTANT MARKERS IN PATIENTS WRIST AND WITHOUT SILENT-MYOCARDIAL-ISCHEMIA AND OVERT UNSTABLE ANGINA-PECTORIS

Ischemic electrocardiographic changes were recorded within 2 hours of admission using a 12-lead electrocardiographic continuous monitor with a 20-second scanning interval and an alarm mode for asymptomatic even ts. Blood samples were obtained at admission and at the moment of asym ptomatic events (group A). In the other patients who did not develop i schemia, a second blood sample was taken 12 hours later (group B). We determined prothrombin time, activated partial thromboplastin time, cl otting factor VIII activity, tissue plasminogen activator activity, ti ssue plasminogen activator inhibitor-1, cross-linked fibrin degradatio n product, and thrombin-antithrombin III complexes. There was a statis tically significant difference between group A and B patients when the basal samples were analyzed for thrombin-antithrombin III (p = 0.046) and d-Dimer (p = 0.005), Prothrombin fragment 1+2 were significantly reduced, and d-Dimer was elevated when basal blood samples were compar ed with the second sample in patients who developed silent events (p = 0.008 and 0.055, respectively). A plasma concentration of thrombin-an tithrombin III complex was also significantly decreased when sample 2 was compared with the basal blood sample (p = 0.039). Five recurrent e pisodes of angina and 2 nonfatal infarctions occurred, and 4 urgent re vascularization procedures were performed in group A. In group B, ther e was only 1 nonfatal infarction (p = 0.01). The results of the presen t study suggest that a time-dependent thrombotic process is detectable in the blood stream as a cyclic movement. Further studies are needed to determine if some other factors, such as intensive shear stress in the vessel wall, may activate plaque instability during asymptomatic e pisodes.