Homocysteine and fibrinolysis in acute occlusive coronary events

Abstract

In their review of homocysteine and vascular disease, Graeme Hankey and John Eikelboom (July 31, p 407)1Hankey GJ Eikelboom JW Homocysteine and vascular disease.Lancet. 1999; 354: 407-413Summary Full Text Full Text PDF PubMed Scopus (863) Google Scholar discuss factors that affect total plasma homocysteine metabolism and variation in fasting plasma homocysteine with lower concentrations during the first hours of an acute occlusive coronary event.2Egerton W Silberberg J Crooks R Ray C Xie L Dudman N Serial measures of plasma homocysteine after acute myocardial infarction.Am J Cardiol. 1996; 77: 759-761Summary Full Text PDF PubMed Scopus (119) Google Scholar It remains uncertain whether the event really depresses plasma homocysteine or triggers a subsequent increase in homocysteine because of a cascade of pathophysiological changes. The effect of fibrinolytic drugs for treatment of acute myocardial infarction on plasma homocysteine is uncertain. We assessed plasma homocysteine concentration in ten consecutive patients (aged 37–83 years) with acute transmural myocardial infarction and systemic thrombolytic therapy with alteplase, streptokinase, or lanoteplase. Serial measurements of plasma homocysteine were done immediately after hospital admission, after application of the thrombolytic agent, 4 h and 24 h later. The measurement of the first three samples were done after fasting from time of admission, the last sample was assessed after fasting for at least 12 h.3Guttormsen AB Scheede J Fiskerstrand T Ueland PM Refsum HM Plasma concentrations of homocysteine and other aminothiol compounds are related to food intake in healthy human subjects.J Nutr. 1994; 124: 1934-1941PubMed Google Scholar We found no significant variation in total plasma homocysteine concentrations during and shortly after treatment of acute transmural myocardial infarction with fibrinolytic drugs. The mean plasma homocysteine concentrations were 12·84 μmol/L (SD 4·69) on admission, 12·38 μmol/L (4·66) after administration of the thrombolytic agents, 11·83 μmol/L (3·86) after 4 h, and 11·48 μmol/L (3·57) after 24 h (p=0·34 for trend across time of homocysteine measurement). Our study shows no apparent effect of systemic fibrinolytic therapy for acute myocardial infarction on total plasma homocysteine concentration and accords with Egerton and colleagues' findings.2Egerton W Silberberg J Crooks R Ray C Xie L Dudman N Serial measures of plasma homocysteine after acute myocardial infarction.Am J Cardiol. 1996; 77: 759-761Summary Full Text PDF PubMed Scopus (119) Google Scholar There was no significant variation in homocysteine during the first 24 h after an acute occlusive coronary event.