Possible mechanism of vascular reocclusion after initially successful thrombolysis with recombinant tissue-type plasminogen activator

Am Heart J. 1991 Jun;121(6 Pt 1):1618-27. doi: 10.1016/0002-8703(91)90004-2.

Abstract

We studied the effects of urokinase (UK), pro-urokinase (pro-UK), and recombinant tissue-type plasminogen activator (rt-PA) on platelet aggregation and the production of thromboxane A2 (TXA2) in vitro. Both UK and pro-UK inhibited the platelet aggregation induced by adenosine 5'-diphosphate (ADP), collagen, or thrombin in a concentration-dependent manner. In contrast, although a low dose of rt-PA (5 to 10 x 10(4) U/ml) blunted platelet aggregability, a high dose (40 to 60 x 10(4) U/ml) led to platelet hyperaggregation. UK and pro-UK markedly inhibited TXA2 synthesis during ADP-induced platelet aggregation. Despite the significant reduction of TXA2 synthesis by 10 x 10(4) U/ml rt-PA, a concentration of 60 x 10(4) U/ml rt-PA had no effect on synthesis. These results indicate that UK and pro-UK each inhibit platelet function, but a high concentration of rt-PA enhances platelet aggregability. This finding may at least in part contribute to the high incidence of reocclusion after initially successful thrombolysis with rt-PA.

Publication types

  • Comparative Study

MeSH terms

  • Coronary Disease / blood
  • Coronary Disease / drug therapy*
  • Coronary Disease / metabolism
  • Fibrinolytic Agents / therapeutic use*
  • Humans
  • Plasminogen Activators / therapeutic use
  • Platelet Aggregation / drug effects
  • Platelet Aggregation Inhibitors / therapeutic use
  • Recombinant Proteins
  • Recurrence
  • Thromboxane B2 / biosynthesis
  • Tissue Plasminogen Activator / therapeutic use*
  • Urokinase-Type Plasminogen Activator / therapeutic use

Substances

  • Fibrinolytic Agents
  • Platelet Aggregation Inhibitors
  • Recombinant Proteins
  • Thromboxane B2
  • Plasminogen Activators
  • Tissue Plasminogen Activator
  • Urokinase-Type Plasminogen Activator