Importance of continued activation of thrombin reflected by fibrinopeptide A to the efficacy of thrombolysis

Paul R. Eisenberg, Laurence Sherman, Michael Rich, David Schwartz, Kenneth Schechtman, Edward M. Geltman, Burton E. Sobel, Allan S. Jaffe

Research output: Contribution to journalArticlepeer-review

116 Scopus citations


Factors responsible for initial success or failure of coronary thrombolysis and persistent recanalization or early reocclusion have not been thoroughly elucidated. Both adequate initial clot lysis and preclusion of rethrombosis are required. Failure may reflect clot lysis followed immediately or somewhat later by rethrombosis. To determine whether differences in the intensity and persistence of the activation of thrombin are determinants of success or failure of recanalization, plasma fibrinopeptide A, a fibrinogen product liberated by thrombin, was serially assayed in 19 patients treated with intravenous streptokinase. In patients exhibiting recanalization (n = 9), plasma fibrinopeptide A decreased after administration of streptokinase but before administration of heparin. In patients without initially apparent recanalization, fibrinopeptide A increased, suggesting ongoing thrombosis, and subsequently decreased promptly after heparin. In patients with initial recanalization followed by overt reocclusion the pattern was different. Despite recanalization, fibrinopeptide A continued to rise markedly. Elevations persisted despite administration of heparin. Thus, inhibition of activation of thrombin is associated with successful recanalization. Conversely, persistent activation of thrombin may be a predisposing factor to both apparent initial failure of recanalization and nvprt early reocclusion.

Original languageEnglish
Pages (from-to)1255-1262
Number of pages8
JournalJournal of the American College of Cardiology
Issue number6
StatePublished - 1986


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