Markers of fibrinolytic potency and clotting activation in stable angina pectoris: role of urokinase, assessment of atrioventricular differences and correlation with coronary patency

To characterize the extent of activation of the hemostatic system and to de tect local alterations which may favour thrombus formation we obtained samp les from the right atrium (RA) and left ventricle (LV) of 60 stable angina patients (mean age 59 years, M/F: 49/11) during the cardiac catheterization procedure. None of the patients had a recent myocardial infarction or angi oplasty. Plasma was prepared from citrated blood samples and the following parameters were determined: thrombin-antithrombin (TAT) complexes, prothrom bin fragment 1+2 (F1+2), plasmin-antiplasmin (PAP) complexes, tissue-type p lasminogen activator (t-PA), plasminogen activator inhibitor (PAI-1) activi ty and the levels of both u-PA activity (scu-PA) and antigen (u-PA Ag). Res ults were correlated with the angiographic findings. The analysis of the di fferent parameters analyzed between patients with coronary stenosis or occl usion in one or more vessels (n=47) and without occlusion (n=13), showed no differences for TAT, PAP, F1+2, and PAI-1 activity between groups. However , a significant increase of t-PA antigen could be demonstrated in patients with occlusion (10.5+/-4.9 ng/ml) as compared to those with angiographicall y-verified coronary patency (7.5+/-3.2 ng/ml) (P<0.03), suggesting that t-P A may be a good marker for occlusion in these patients. u-PA results showed the lowest ratio in the more severe patients (59 vs 66%) (P<0.05). The scu -PA/u-PA ratio was also significantly reduced in the sample taken from RA a s compared with LV (P<0.001). Our results point to an enhanced local activa tion of the fibrinolytic system in the more severe patients with stable ang ina pectoris and to atrioventricular differences in the u-PA components.