FRAGMENTATION-PATTERN OF FIBRINOGEN DURING THROMBOLYSIS IN ACUTE MYOCARDIAL-INFARCTION WITH FIBRIN-SPECIFIC PLASMINOGEN ACTIVATORS - DETECTION OF HIGH-MOLECULAR-WEIGHT FIBRINOGEN DEGRADATION PRODUCTS

In thrombolysis in acute myocardial infarction, the fibrin-specific pl asminogen activators are infused in non-physiologically high doses, On ly limited fibrin-specific in nature, this may give rise to extensive fibrinogen degradation. In a series of 65 patients - 24 rt-PA, 41 pro- urokinase - we investigated, whether fibrinogen degradation follows a similar fragmentation pattern as known from thrombolysis with streptok inase. During thrombolysis, fibrinogen levels were stable (3.2 +/- 1.7 before and 3.1 +/- 1.3 g/l at 2 hours), whereas plasminogen and alpha (2)-antiplasmin levels decreased from 96.1 +/- 23.8 to 59,3 +/- 25.6 a nd 93.4 +/- 26.9 to 31.9 +/- 32.4%, respectively. Simultaneously low m olecular weight fibrinogen - and fibrin degradation products increased from 0.55 +/- 0.42 to 3.31 +/- 5.69 mg/l and from 0.61 +/- 0.83 to 6. 58 +/- 6.78 mg/l respectively. Moreover high molecular weight fibrin d egradation products (250-300,000 D) were detected in the plasmas of 14 pts (8 pro-urokinase, 6 rt-PA) with means of SDS-PAGE (Polyacrylamide -gradient 6-12%, 250 V, 30 mA, silver staining). Furthermore generatio n of high molecular weight degradation products was correlated to cons umption of the plasminogen and alpha(2)-antiplasmin. Thus the fibrinog en fragmentation pattern of all plasminogen activators is similar and is correlated to the extent of systemic lytic state.