Boinska Joanna, Koziński Marek, Kasprzak Michał, Ziołkowski Michał, Kubica Jacek, Rość Danuta
Department of Pathophysiology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-094 Bydgoszcz, Poland.
Department of Cardiology and Internal Diseases, Institute of Maritime and Tropical Medicine, Faculty of Health Sciences, Medical University of Gdańsk, 81-519 Gdynia, Poland.
J Clin Med. 2022 Nov 30;11(23):7105. doi: 10.3390/jcm11237105.
There is limited information about diurnal changes in fibrinolysis parameters after acute myocardial infarction (AMI) and their relationship with on-treatment platelet reactivity. The aim of this study was to assess tissue plasminogen activator (t-PA), plasminogen activator inhibitor type-1 (PAI-1), α2-antiplasmin (α2-AP) activity, and plasmin-antiplasmin (PAP) complexes in 30 AMI patients taking dual antiplatelet therapy (DAPT), i.e., acetylsalicylic acid and clopidogrel. Fibrinolytic parameters were assessed at four time points (6 a.m., 10 a.m., 2 p.m., and 7 p.m.) on the third day after AMI using immunoenzymatic methods. Moreover, platelet reactivity was measured using multiple-electrode aggregometry, to assess potential differences in fibrinolytic parameters in low/high on-aspirin platelet reactivity and low/high on-clopidogrel platelet reactivity subgroups of patients. We detected significant diurnal oscillations in t-PA and PAI-1 levels in the whole study group. However, PAP complexes and α2-AP activity were similar at the analyzed time points. Our study reveals a potential impact of DAPT on the time course of fibrinolytic parameters, especially regarding clopidogrel. We suggest the presence of diurnal variations in t-PA and PAI-1 concentrations in AMI patients, with the highest levels midmorning, regardless of platelet reactivity. Significantly elevated levels of PAI-1 during the evening hours in clopidogrel-resistant patients may increase the risk of thrombosis.
关于急性心肌梗死（AMI）后纤溶参数的昼夜变化及其与治疗中血小板反应性的关系，目前信息有限。本研究旨在评估30例接受双重抗血小板治疗（DAPT）（即阿司匹林和氯吡格雷）的AMI患者的组织纤溶酶原激活物（t-PA）、纤溶酶原激活物抑制剂1型（PAI-1）、α2-抗纤溶酶（α2-AP）活性以及纤溶酶-抗纤溶酶（PAP）复合物。在AMI后第三天的四个时间点（上午6点、上午10点、下午2点和晚上7点），采用免疫酶法评估纤溶参数。此外，使用多电极聚集法测量血小板反应性，以评估患者低/高阿司匹林血小板反应性和低/高氯吡格雷血小板反应性亚组中纤溶参数的潜在差异。我们在整个研究组中检测到t-PA和PAI-1水平存在显著的昼夜波动。然而，在分析的时间点，PAP复合物和α2-AP活性相似。我们的研究揭示了DAPT对纤溶参数时间进程的潜在影响，尤其是关于氯吡格雷。我们认为AMI患者的t-PA和PAI-1浓度存在昼夜变化，上午中旬水平最高，与血小板反应性无关。氯吡格雷抵抗患者在夜间PAI-1水平显著升高可能会增加血栓形成的风险。
