Increased levels of plasma thrombomodulin in patients with acute myocardial infarction who had thrombolytic therapy and achieved successful reperfusion

Background: There is a growing body of evidence from animal and in vitro st udies for the existence of reperfusion injury after thrombolytic therapy fo r acute myocardial infarction (AMI), but the patient data are limited. Hypothesis: We aimed to examine the plasma thrombomodulin (TM) levels as a marker of endothelial injury and to investigate the effect of successful re perfusion on these levels. Methods: The study included 32 patients who had a first episode of acute my ocardial infarction (AMI) and received intravenous streptokinase therapy. Results: Thrombomodulin levels increased significantly at 60 min after thro mbolysis compared with the levels before thrombolytic therapy (0 min) in 21 (66%) patients who had successful reperfusion (49.09 +/- 10.51 vs. 25.76 /- 5.55 ng/ml, p < 0.001). There was no difference between the TM levels at 0 and at 60 min of thrombolysis in the remaining 11 (34%) patients who cou ld not achieve reperfusion (27.81 +/- 6.32 vs. 28.72 +/- 7.28 ng/ml, p = 0. 35). Conclusion: There was a significant increase in TM levels at 60 min after t hrombolysis in a group of patients with AMI who achieved successful reperfu sion; this increase may have been caused by the activation/injury of endoth elial cells. Data also suggest that the increment in TM levels may be predi ctive of the potential success of thrombolytic therapy.