Fragmentation pattern of fibrinogen during thrombolysis in acute myocardial infarction with fibrin-specific plasminogen activators — Detection of high-molecular weight fibrinogen degradation products

Abstract

In thrombolysis in acute myocardial infarction, the fibrin-specific plasminogen activators are infused in non-physiologically high doses. Only limited fibrin-specific in nature, this may give rise to extensive fibrinogen degradation. In a series of 65 patients — 24 rt-PA, 41 pro-urokinase — we investigated, whether fibrinogen degradation follows a similar fragmentation pattern as known from thrombolysis with streptokinase. During thrombolysis, fibrinogen levels were stable (3.2 ± 1.7 before and 3.1 ± 1.3 g/l at 2 hours), whereas plasminogen and α 2-antiplasmin levels decreased from 96.1 ± 23.8 to 59.3 ± 25.6 and 93.4 ± 26.9 to 31.9 ± 32.4%, respectively. Simultaneously low molecular weight fibrinogen — and fibrin degradation products increased from 0.55 ± 0.42 to 3.31 ± 5.69 mg/l and from 0.61 ± 0.83 to 6.58 ± 6.78 mg/I respectively. Moreover high molecular weight fibrin degradation products (250–300,000 D) were detected in the plasmas of 14 pts (8 pro-urokinase, 6 rt-PA) with means of SDS-PAGE (Polyacrylamide-gradient 6–12%, 250 V, 30 mA, silver staining). Furthermore generation of high molecular weight degradation products was correlated to consumption of the plasminogen and α 2-antiplasmin. Thus the fibrinogen fragmentation pattern of all plasminogen activators is similar and is correlated to the extent of systemic lytic state.