Nichols W W, Nicolini F A, Khan S, Saldeen T G, Mehta J L
Department of Medicine, University of Florida College of Medicine, Gainesville.
Am Heart J. 1993 Aug;126(2):285-92. doi: 10.1016/0002-8703(93)91041-c.
The coronary artery often reoccludes soon after the flow has been restored with recombinant tissue-type plasminogen activator (TPA) in dogs with electrically-induced thrombosis. The coronary artery reocclusion relates to intense in situ platelet activation and thrombin generation in the reperfused coronary artery. To determine the effect of a potent platelet inhibitor, the prostacyclin analog iloprost, in the prevention of coronary artery reocclusion, an occlusive thrombus was created in the left anterior descending coronary artery in 23 dogs. Coronary artery reflow occurred in 17 dogs after TPA (1 mg/kg over 20 minutes intravenously) administration. After the reflow was established, 10 dogs were given saline and 7 dogs were given iloprost (4 micrograms/kg over 40 minutes). In the saline-treated group, the coronary artery reoccluded in 8 of 10 dogs over 90 minutes (reocclusion rate 80%). In the iloprost-treated group, the coronary artery reoccluded in five of seven dogs (reocclusion rate 71%; p = NS vs TPA alone). The magnitude of peak coronary blood flow and duration of flow were similar in dogs given saline or iloprost after TPA-induced thrombolysis. Scanning electron microscopy showed residual thrombus and the appearance of coronary arterial narrowing distal to the thrombus in all dogs examined. Thus residual thrombus formation and coronary artery narrowing continue to occur after TPA-induced thrombolysis in dogs whether the animals are treated with saline or iloprost. Administration of iloprost after reflow does not modulate the frequency of coronary artery reocclusion.
在用电诱导血栓形成的犬中，使用重组组织型纤溶酶原激活剂（TPA）恢复血流后，冠状动脉常很快再次闭塞。冠状动脉再闭塞与再灌注冠状动脉中强烈的原位血小板活化和凝血酶生成有关。为了确定强效血小板抑制剂前列环素类似物伊洛前列素在预防冠状动脉再闭塞中的作用，在23只犬的左前降支冠状动脉中制造了闭塞性血栓。静脉注射TPA（1mg/kg，持续20分钟）后，17只犬出现冠状动脉再灌注。再灌注建立后，10只犬给予生理盐水，7只犬给予伊洛前列素（4μg/kg，持续40分钟）。在生理盐水治疗组中，10只犬中有8只在90分钟内冠状动脉再次闭塞（再闭塞率80%）。在伊洛前列素治疗组中，7只犬中有5只冠状动脉再次闭塞（再闭塞率71%；与单独使用TPA相比，p=无显著性差异）。TPA诱导溶栓后给予生理盐水或伊洛前列素的犬，冠状动脉血流峰值大小和血流持续时间相似。扫描电子显微镜显示，在所有检查的犬中均有残余血栓，且血栓远端冠状动脉出现狭窄。因此，无论动物接受生理盐水还是伊洛前列素治疗，TPA诱导溶栓后犬体内仍会继续形成残余血栓和冠状动脉狭窄。再灌注后给予伊洛前列素并不能调节冠状动脉再闭塞的频率。
