An increased thrombin generation is detectable for at least 1 week following elective percutaneous transluminal coronary angioplasty

Objective: The present prospective study was planned to investigate: (1) ho w long the early haemostatic changes after PTCA last and (2) if some coagul ation and/or fibrinolytic parameters assessed during the first month after PTCA may be predictive of subsequent clinical recurrence. Setting. Istituto di Clinica Medica Generate e Cardiologia, University of F lorence, Florence, Italy. Material and Methods: In 72 patients undergoing PTCA fibrinogen, F1+2, TAT, D-dimer and ELT were evaluated before the procedure (T1) and 2 (T2), 7 (T7 ) and 30 days (T30) after PTCA; PAI-1 and t-PA were assessed before PTCA an d after 7 and 30 days. Follow-up angiography was performed only in patients with recurrence of ischaemia or positive ergometric tests. Results: F1+2, TAT and fibrinogen were significantly increased at T2 (P<0.0 05); after a week, F1+2 and fibrinogen were still significantly higher in c omparison to baseline values (P <0.005). At T30 these parameters showed sig nificantly lower levels if compared to Tt (P<0.005). Plasma D-dimer concent ration significantly increased at T2 and T7 (P<0.001), but no difference wa s found between baseline Values and those at T30. PAI-1 activity significan tly decreased at T7 (P<0.001), whereas it was similar to baseline at T30. N o significant variations of t-PA levels were observed at the different time s. Finally, ELT significantly increased at T2 (P<0.001), but at T7 and T30 the values were similar to baseline values. Clinical recurrence occurred in 19 patients. The values of various parameters investigated were not differ ent at any time considered between the patients with and without subsequent clinical recurrence. Heparin treatment had no significant influence on thr ombin generation at different times whereas it had marginal influences on f ibrinogen, PAI-1 and t-PA antigen levels. Conclusion: A number of alterations in haemostasis takes place and persists 2 and 7 days after elective PTCA and heparin treatment is not able to blun t clotting activation. The haemostatic parameters assessed during the first month after PTCA seem not to be predictive of subsequent clinical recurren ce. (C) 2000 Harcourt Publishers Ltd.