Changes of hemostasis, endogenous fibrinolysis, platelet activation and endothelins after percutaneous transluminal coronary angioplasty in patients with stable angina

OBJECTIVES This study investigated parameters of endogenous fibrinolysis, a ctivation of coagulation and platelets, and endothelin levels before and af ter elective percutaneous transluminal coronary angioplasty (PTCA) in patie nts with stable coronary artery disease (CAD). BACKGROUND Abrupt vessel closure is a serious short-term complication after PTCA and is often unforeseeable. Detailed insight into the effect of PTCA on hemostasis, platelets and the release of vasoconstrictive substances, wh ich are among the mainly discussed mechanisms of abrupt vessel closure, is needed to enhance the safety of coronary intervention. METHODS Plasma levels of markers of platelet activity, coagulation, endogen ous fibrinolysis and endothelins were determined in 20 patients with stable CAD undergoing elective PTCA. The blood specimens were drawn before, immed iately after, 1 h after intervention and on the next morning. RESULTS All patients showed an initially uncomplicated PTCA. Regarding the efficacy of anticoagulation after receiving 15.000 IU heparin during PTCA, two groups were compared. In eight patients with ineffective anticoagulatio n production of thrombin and platelet activation directly after and 1 h aft er PTCA was significantly higher compared with 12 patients with effective a nticoagulation. Despite the strong activation of coagulation, only a low fi brinolytic response could be observed. Endothelins rose significantly after PTCA in both groups but stayed longer on higher levels in patients with di stinct thrombin generation. Three of the eight patients without sufficient heparin treatment suffered abrupt vessel closure. CONCLUSION Initially uncomplicated dilation of coronary arteries leads to s ystemically measurable activation of coagulation and platelets in patients with ineffective doses of heparin and release of endothelins in all patient s. Therefore, individual adjustment of anticoagulation and platelet inhibit ion in combination with effective antivasospastic substances are needed in every patient before, during and after initially uncomplicated PTCA to prev ent this serious complication. (C) 1999 by the American College of Cardiolo gy.