Time course of platelet aggregation during thrombolytic treatment of massive pulmonary embolism

• DOI: 10.1097/mbc.0b013e3282e38e61
• Publication Date: 2009-03-04T22:44:38Z
• Authors: Diána Mühl; Réka Füredi; Krisztián Gecse; Subhamay Ghosh; Boglárka Falusi; Lajos Bogár; Elisabeth Rőth; János Lantos
• Keywords: Adult; Aged, 80 and over; Blood Platelets; Adolescent; Platelet Aggregation; Fibrinogen; Middle Aged; Recombinant Proteins; 3. Good health; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Fibrinolytic Agents; Tissue Plasminogen Activator; Humans; Streptokinase; Thrombolytic Therapy; Pulmonary Embolism; Aged

We studied changes in platelet aggregation and fibrinogen levels during thrombolysis with massive or submassive pulmonary embolism. Fifteen patients were randomized into ultrahigh-dose streptokinase (UH-SK n = 8) or alteplase (tPA n = 7) groups. Arterial blood samples were taken before and after thrombolysis every 4 h between 4 and 36 h, and once daily between 2 and 30 days. In-vitro platelet aggregation was examined as spontaneous (0.9% NaCl) and induced aggregation with adrenaline 10 micromol/l, collagen 2 microg/ml and ADP 10 micromol/l. D-dimer and fibrinogen were measured every 8 h on first day, and later as above. In the UH-SK group, adrenaline-induced platelet aggregation decreased at 4 and 8 h compared with baseline (P < 0.03). Adrenaline-induced platelet aggregation was significantly lower in the UH-SK group than in the tPA group at 36 h and on day 3 (P < 0.03). Platelet aggregation induced by ADP was lower at 4 h than at baseline in the UH-SK group (P < 0.05). Collagen-induced platelet aggregation was lower at 4 and 8 h than at baseline (P < 0.05) in the UH-SK group. Compared with baseline, fibrinogen levels decreased in both groups after thrombolysis. D-dimer levels were elevated in both groups at 8 h (tPA group, P < 0.0004; UH-SK group, P < 0.05). Spontaneous platelet aggregation, major bleeding or re-embolism was not documented. Platelet aggregation decreased after thrombolysis with UH-SK for 12 h, in comparison tPA caused an insignificant decrease. Fibrinogen level decreased with UH-SK treatment for 5 days but in case of tPA we could not measure significant changes. According to our findings, tPA is a more suitable drug but streptokinase is also effective because of its cost-benefit ratio.