Camilleri J F, Bonnet J L, Bouvier J L, Levy G, Djiane P, Bory M, Serradimigni A
CHU Timone, service de cardiologie, Marseille.
Arch Mal Coeur Vaiss. 1988 Sep;81(9):1037-41.
In this retrospective study the data of 70 patients treated with streptokinase in the acute phase of myocardial infarction were reviewed in search of a possible relation between recurrent ischaemic events and degree of anticoagulation. All patients had received a 30 mn infusion of streptokinase 1.500.000 units within a mean 175 mn period from the initial symptoms. They were followed up clinically (signs of angina or infarction), angiographically (coronary arteriography within 5.5 days on average) and biochemically (daily measurements of TCA values and blood fibrinogen concentrations). Fifteen recurrent ischaemic events (21.4 p. 100), including 6 attacks of angina and 9 myocardial infarctions, were observed. Angiography showed that the artery responsible for the initial infarction was occluded in 23.6 p. 100 (13/55) of patients without recurrent ischaemic accident. This figure rose to 46.6 p. 100 in patients who suffered a new anginal attack (7/15; NS) and up to 77 p. 100 in those who developed a new myocardial infarction (7/9; p less than 0.01). Biochemical data showed that 13 recurrent ischaemic accidents occurred when the APTT values were lower than 1.5 (176 measurements), as against 2 when these values were higher than 1.5 (359 measurements) (p less than 0.01). These two recurrent ischaemic accidents took place when fibrinogen concentrations abruptly rose above 1 g/litre. These results demonstrate that poor quality anticoagulation is responsible for the occurrence of recurrent ischaemic events within days of thrombolysis for acute myocardial infarction. They prompt the authors to recommend anticoagulation with heparin started at an early stage and carefully adjusted by means of repeated biochemical essays.
在这项回顾性研究中，对70例在心肌梗死急性期接受链激酶治疗的患者的数据进行了回顾，以寻找再发性缺血事件与抗凝程度之间的可能关系。所有患者在出现初始症状后的平均175分钟内接受了30分钟的150万单位链激酶输注。对他们进行了临床随访（心绞痛或梗死迹象）、血管造影随访（平均在5.5天内进行冠状动脉造影）和生化随访（每日测量三氯乙酸值和血液纤维蛋白原浓度）。观察到15例再发性缺血事件（21.4%），包括6次心绞痛发作和9次心肌梗死。血管造影显示，在没有再发性缺血事件的患者中，导致初始梗死的动脉在23.6%（13/55）的患者中闭塞。在发生新的心绞痛发作的患者中，这一数字上升至46.6%（7/15；无显著性差异），而在发生新的心肌梗死的患者中则高达77%（7/9；P<0.01）。生化数据显示，当活化部分凝血活酶时间（APTT）值低于1.5时，发生了13例再发性缺血事件（176次测量），而当这些值高于1.5时，发生了2例（359次测量）（P<0.01）。这两例再发性缺血事件发生在纤维蛋白原浓度突然升至1g/升以上时。这些结果表明，抗凝质量差是急性心肌梗死溶栓治疗数天内再发性缺血事件发生的原因。它们促使作者建议早期开始用肝素抗凝，并通过反复生化检测仔细调整。
