Correlation Study of Color Doppler Examination of Deep Veins of Both Lower Extremities Combined with Fibrinolysis System in Hypertension during Pregnancy

Objective: To investigate the correlation between deep static color Doppler ultrasound of both lower extremities combined with fibrinolytic system detection in pregnancy-induced hypertension. Methods: A total of 70 normal pregnant women, 70 pregnant women with hypertension during pregnancy, and 50 healthy non-pregnant women in the same period were selected as the research objects. The deep veins of both lower limbs were examined by Rili Erlangshen’s color Doppler ultrasound diagnostic instrument (CDU), and the fibrinolysis system was tested by enzyme-linked immunosorbent assay (ELISA) method and automatic hemagglutination analyzer. Results: Compared with the non-pregnant group, the inner diameters of the left/right femoral vein (CFV) and popliteal vein (POV) in the normal pregnancy group and the pregnancy-induced hypertension group were significantly widened, and the peak blood flow spectrum was significantly reduced. The difference was statistically significant (P < 0.01);FIB, PLG, t-PA, PAI, D-Dimer were significantly increased, the difference was statistically significant (P < 0.01);Compared with the normal pregnancy group, the inner diameter of the left/right femoral vein (CFV) in the hypertensive pregnancy group was significantly wider than that in the normal pregnancy group, and the peak value of the left/right POV blood flow spectrum was significantly lower than that in the normal pregnancy group, the difference was statistically significant (P < 0.01), while the left/right popliteal vein (POV) inner diameter, left/right CFV blood flow peak value did not change significantly from the normal pregnancy group, and the difference was not statistically significant (P > 0.05);FIB, PLG, PAI, D-Dimer of the hypertensive disease group during pregnancy significantly increased, the difference was statistically significant (P < 0.01), while t-PA was not statistically significant (P > 0.05). Conclusion: Normal pregnant women have a hypercoagulable state compared with healthy non-pregnant women, and pregnant women with hypertension during pregnancy are more likely to be in a pre-thrombotic state than pregnant women with normal pregnancy. Deep vein CDU examination of both lower extremities combined with blood fibrinolysis monitoring is of great value in the prevention and treatment of hypertension during pregnancy.

Combination of Shuxuetong and aspirin protects against cerebral ischemia/reperfusion injury through ameliorating coagulation and fibrinolysis system

Objective：To explore the influence of the combination of Shuxuetong（SXT）and aspirin on coagulation and fibrinolytic system of rats.Methods：Suture method was applied to establish focal cerebral ischemia-reperfusion injury models in rats.SD rats were randomly divided into sham group,middle cerebral artery occlusion/reperfusion（MCAO/R）group,aspirin group,SXT group,and SXT＋aspirin group（S＆A）.The neurological deficits were assessed according to Longa’s grade 5 scoring method.The cerebral edema was detected by measuring the content of water in brain tissue.The volume of cerebral infarction was observed by 2,3,5-Triphenyltetrazolium chloride（TTC）staining.Blood plasma was collected by abdominal aortic method to test maximum platelet aggregation rate and four blood coagulation.CD61,CD62p,6-keto prostaglandin F1αantithrombinⅢ（AT-Ⅲ）,D-dimer,plasminogen activator inhibitor-1（PAI-1）,tissue factor（TF）,tissue plasminogen activator（t-PA）,platelet thromboxaneand von Willebrand factor（v WF）content in rat plasma were detected by ELISA.Results：SXT combined with aspirin could improve the neurological deficits,alleviate cerebral edema,and decrease the cerebral infarct value.Compared with the sham operation group,fibrinogen（FIB）,6-AT-III,and t-PA in model group were significantly decreased;Compared with the model group,the above-mentioned indexes in SXT and aspirin treatment group were significantly increased.The prothrombin time（PT）,activated partial thromboplastin time（APTT）,thrombin time（TT）,D-dimer,PAI-1,TF,TXB2,and v WF of the model group were significantly increased;The above-mentioned indexes in blood SXT＋aspirin treated group were significantly decreased.There was a significant difference between the combined group and SXT group.The maximum concentration of plateletsin aspirin treated rats was significantly decreased,however,MPAR was reversed in SXT＋aspirin treated group.Conclusion：SXT combined with aspirin can effectively inhibit platelet activation,regulate the maximum concentration of platelets,and improve coagulation function and fibrinolysis system.

Effect of fibrinolytic therapy on ST-elevation myocardial infarction clinical outcomes during the COVID-19 pandemic:A systematic review and meta-analysis

BACKGROUND ST-elevation myocardial infarction(STEMI)is the result of transmural ischemia of the myocardium and is associated with a high mortality rate.Primary percutaneous coronary intervention(PPCI)is the recommended first-line treatment strategy for patients with STEMI.The timely delivery of PPCI became extremely challenging for STEMI patients during the coronavirus disease 2019(COVID-19)pandemic,leading to a projected steep rise in mortality.These delays were overcome by the shift from first-line therapy and the development of modern fibrinolytic-based reperfusion.It is unclear whether fibrinolytic-based reperfusion therapy is effective in improving STEMI endpoints.AIM To determine the incidence of fibrinolytic therapy during the COVID-19 pandemic and its effects on STEMI clinical outcomes.METHODS PubMed,Google Scholar,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials were queried from January 2020 up to February 2022 to identify studies investigating the effect of fibrinolytic therapy on the prognostic outcome of STEMI patients during the pandemic.Primary outcomes were the incidence of fibrinolysis and the risk of all-cause mortality.Data were meta-analyzed using the random effects model to derive odds ratios(OR)and 95%confidence intervals.Quality assessment was carried out using the Newcastle-Ottawa scale.RESULTS Fourteen studies including 50136 STEMI patients(n=15142 in the pandemic arm;n=34994 in the pre-pandemic arm)were included.The mean age was 61 years;79%were male,27%had type 2 diabetes,and 47%were smokers.Compared with the pre-pandemic period,there was a significantly increased overall incidence of fibrinolysis during the pandemic period[OR:1.80(1.18 to 2.75);I2=78%;P=0.00;GRADE:Very low].The incidence of fibrinolysis was not associated with the risk of all-cause mortality in any setting.The countries with a low-and middle-income status reported a higher incidence of fibrinolysis[OR:5.16(2.18 to 12.22);I2=81%;P=0.00;GRADE:Very low]and an increased risk of all-cause mortality in STEMI patients[OR:1.16(1.03 to 1.30);I2=0%;P=0.01;GRADE:Very low].Meta-regression analysis showed a positive correlation of hyperlipidemia(P=0.001)and hypertension(P<0.001)with all-cause mortality.CONCLUSION There is an increased incidence of fibrinolysis during the pandemic period,but it has no effect on the risk of all-cause mortality.The low-and middle-income status has a significant impact on the all-cause mortality rate and the incidence of fibrinolysis.

Thrombin Activatable Fibrinolysis Inhibitor in Preeclmapsia and Gestational Hypertension throughout the Gestation

To clarify the role of TAFI in hypertensive disorders in pregnancy, 22 subjects, including 10 with pre-eclampsia （PE） and 12 with gestational hypertension were examined for the levels of TAFI and thrombin-antithrombin （TAT） complex. Thirty normal pregnant women served as controls. ELISA was employed for the detection. The results showed that the TAFI antigen levels in normal pregnancy group, gestational hypertension group and PE group were （85.35±24.69）%, （99.65±18.27）%, （110.12±23.36）%; （97.06±21.40）%, （114.08±27.76）%, （125.49±24.70）%; （106.6±19.21）%, （129.2±25.07）%, （139.1±30.12）%, in the 1st, 2nd and 3rd trimester respectively. No significant differences were found between the normal pregnancy group and gestational hypertension group but significant difference existed between normal pregnancy group and PE group in each trimester （P〈0.05）. TAT complexes were significantly higher in patients with PE than that in controls （P〈0.05）, but no correlation was found between TAT and TAFI. It is concluded that TAFI may contributed to the impairment of fibrinolysis in the patients with PE and may serves as a sensitive indicator for PE, but it may not help in the diagnosis of the gestational hypertension.

Tranexamic acid for the management of uterine fibroid tumors:A systematic review of the current evidence

AIM: To conduct a detailed systematic review of the current evidence on the administration and efficacy of tranexamic acid in patients with menorrhagia due to uterine fibroids. METHODS: We conducted an electronic search on the following databases Pub Med and Medline(1950-2013);(1980-2013); Cochrane library(1993-2013). RESULTS: A total of 36 articles were retrieved after the initial electronic search. Careful assessment of the retrieved studies led to the final selection of 5 articles for inclusion in the review. CONCLUSION: Tranexamic acid may reduce blood loss perioperatively in myomectomies. It may reduce the menorrhagia in patients with fibroids, however a stratification of fibroids by size and location is required to define the responses. It is safe in general, with mild adverse effects observed in some cases. More studies with a double-blind randomized design and larger numbers of participants are necessary to reach more precise and safe conclusions.

Study on Localization Factors of Coagulation and Fibrinolysis in Glomerulonephritis

The intraglomerular distribution of alpha 2-plasmin inhi-bitor (α2-PI), plasminogen (PLG), fibronectin (FN) andfibrinogen related antigen (FRA), were examined in 118 ca-ses of primary or secondary glomerular disease by immuno-fluorescence method. The plasma concentrations of α2-PI,PLGand FRA were also measured simultaneously. The results ofthis study indicated that there was significant correlationbetween the deposition of α2-PI, PLG, FN, FRA and thedegree of histopathological changes in patients with severeglomerulonephritis. There was no significant correlation be-tween the intensity of α2-PI, PLG, FN and FRA depositionin glomeruli and the serum levels of α2-PI, PLG and FRA.

The Role of Fibrinolysis in Adhesive Otitis Media(AOM)

Objective To study the effects of Batroxobin on otitis media with effusion(OME), an early stage of Adhesive Otitis Media(AOM), for the purpose of expanding our understanding of the role of fibrinolysis in the pathogenesis of AOM. Method Forty cases of OME(45 ears) were randomly selected to receive intratympanic administration of Dexamethasone at 5 mg/ml(Group 1 or G1), Batroxobin at 1 BU/ml(Group 2 or G2) or Batroxobin at 2 BU/ml (Group 3 or G3). Pre-and post-treatment changes in clinical symptoms, the Air conduction Hearing Threshold (AHT) in pure tone audiometry and average AHT over 0.25 to 2 kHz were compared. Results Data from 31 cases(33 ears) were available for analysis. AHTs among three groups were similar prior to treatment(P > 0.05). The rate of normal hearing following treatment in G3 was 70% or 7 / 10, higher than in G1(41.7% or 5 / 12) and G2 (54.5% or 6 / 11)(P < 0.05). The rate of improvement following treatment was 81.8% or 9/11 and 80.0% or 8 / 10 in G2 and G3, respectively, higher than that in G1(50.0% or 6 / 12)(P < 0.05). Conclusions Therapeutic effects of intratympanic injection of Batroxobin on OME is superior to traditionally used Dexamethasone. In addition, higher concentration of Batroxobin appears to be superior to lower concentrations. These findings confirm that fibrinolysis plays a pivotal role in the pathogenesis of middle ear adhesion and that fibrinolytic medicine can prevent or reduce adhesion development in the middle ear.

THE IMPAIRMENT OF PLATELET FUNCTION IN FIBRINOLYSIS AND PRESERVING EFFECT OF APROTININ

Platelet adhesion depends on the platelet membrane glycoprotein Ib (GPIb) and plasma von Willebrand Factor (vWF), which can be reflected by ristocetin-induced aggregation. Here we report damage effect of fibrinolysis and preserving effect of aprotinin on platelet function. Addition of 40 U/ml urokinase and 0.3 U/ml plasmin to PRP or washed platelets made the ristocetin-induced aggregation decline to 31.6% and 38.5% of control value respectively. The extent of declining was positively correlated with the concentration of urokinase and plasmin. Meanwhile, the platelet GPIb decreased to 76.4% of control value. The results showed that the fibrinolysis impaired the platelet function and this effect may be associated with the hydrolysis of GPIb. Further research found that by adding the same dose of urokinase or plasmin to aprotinin-pretreated PRP or washed platelets, the aggregation did not change statistically and decrement of GPIb is much less marked. We concluded that the aprotinin could relieve the platelet dsfunction effectively by its inhibitory effect on fibrinolytic activity.

A Comparison Study of the Effects Injectable Contraceptive Cyclofem on Blood Coagulation and Fibrinolysis

Forty-six healthy women received Cyclofem (25mg medroxyprogesterone acetate with sing estradiol cypionate) and other /orly--five women, as control,received oral contraceptive pill (Ortho--Novum 1/35, containing norethisterone enantate ling and estradiol valerate 35fig) for nine months. Blood samples were taken during the follicular and luteal phases o/preu treatment, and for Cyclofem group, immediately prior to the 3rd and gth injections and 1 and 3 weeks a/ter the 3rd and gth injections, for Ortho Novum group, blood samples were taken on the irst day o[.the 3rd and gth pill cycles and 1 and 3 weeks later in both cycles. For both groups after at least 3 months nonhormonal method of contraception, blood sampling was repeated at follicular and luteal phases of a normal mentrual cycle.Coagulation and librinolysis parameter were detected including hemoglobin,platelet count, prothrombin time, APTT, fibrinogen, factor Vll, [actor X,plasminogen, in PAl, AT Ill (functional and immunological assays) and protein C.In the Cyclolem group, hemoglobin, platelet count, fibrinogen and /Octor X were not changed. Factor Vll significantly reduced. Prothrombin time and APTT showed minor changes. Plasminogen and protein C decreased while t-- PAl and AT 11.1 increased. These changes showed a dynamic balance between coagulatioll and fibrinolysis. In Ortho---Novum 1/35 group, platelet count, jactor X and [ibrinogen increased and prothrombin time and APTT accelerated. In fibrinolysis and anticoagulation system, plasminogen increased as well as protein C, but AT Ill declined. Those changes showed a tendency o[ hyper-coagulabllity state, fibrinolysis and anticoagulation were enhanced to a certain extent.The result of our study is that there are slight 'changes on coagulation and [ibrinolyls is in Cyclofem injectable contraceptive users.

Change and significance of fibrinolysis in coronary heart disease patients with angina pactoris

Objectives To study change and the clinical significance of fibrinolysis in coronary heart disease(CHD) patients with angina pactoris(AP).Methods Levels of plas-min plasminogen activator inhibitor-1(PAI-1),tissue-type plasminogen activator(t-PA),fibrinogen(FIB) in 110 CHD patients with AP and 20 normal cases as control group were analyzed in the same ways.Results Levels of PAI-1,FIB in CHD patients with AP were significantly higher than those in control cases,and those of t-PA were significantly lower than control cases;Levels of PAI-1,FIB in UA patients with UA heart events were significantly higher than those in patients with SA,and those of t-PA were significantly lower than patients with SA;Levels of PAI-1,FIB in patients with AP events were significantly higher than those in patients without AP events,and those of t-PA were significantly lower than patients without AP events.Conclusions There was abnormal of fibrinolysis function in CHD patients with AP, specially in patients with UA or with AP events,the abnormal of fibrinolysis might be play an important rule in coronary heart disease(CHD) patients with angina pactoris.

Effect of massive blood transfusion on blood coagulation function and fibrinolytic system in patients with acute trauman

Objective:To investigate the effect of a large number of blood transfusion on coagulation function and fibrinolytic system in patients with acute trauma.Methods:A total of 86 cases of traumatic blood transfusion emergency and hospitalized patients during January 2014 to January 2016 in our hospital, divided into two groups according to the early blood transfusion, acute trauma patients need a lot of blood transfusion for the observation group (47 cases), trauma patients need a small amount of blood transfusion as the control group (39 cases). Statistical analysis and comparison of two groups patients of four blood coagulation [prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT), fibrinogen (FIB)], platelet count (PLT), protein C (PC) and fiber soluble system index [D dimer (D-D), fibrin degradation products (FDP) levels before and after blood transfusion of 1 d, 5 d'. Results:Before blood transfusion, there was no significant difference between the two groups. There was no significant difference in the level of the observed indexes in the control group before and after transfusion. 1 d after blood transfusion, compared with blood transfusion before and the control group at the same time , the observation group PT[(18.4±4.3) s], APTT[(42.9±7) s], TT[(21.4±4.8) s] were significantly prolonged, D-D[(282.2±115) g/L] and FDP[(6.3±2.1) mg/L] were significantly increased, and FIB[(2.9±1.3) g/L], PLT[(72.5±34.4) 109] and PC[(2.4±1.2) mg/L] levels were significantly decreased. 5 d after blood transfusion, compared with blood transfusion before and the control group at the same time ,the observation indexes showed no significant difference;5 D after blood transfusion compared with 1 D, the observation group PT[(14.8±1.7) s], APTT[(34.7±5.4) s], TT[(14.7±2.5) s] was significantly shortened, D-D[(151.8±62.4) g/L] and FDP[(3.7±1.2) mg/L] were significantly decreased, FIB[(3.7±0.8) g/L], PLT[(179±70.8) 109] and PC[(3.9±1.5) mg/L] levels were significantly higher.Conclusion:Large amount of blood transfusion has great influence on the coagulation function and fibrinolysis system in acute trauma patients. It is necessary to monitor coagulation status in time and avoid complications such as coagulation dysfunction, so as to improve the success rate of implementation of massive transfusion regimen.

Effect of urokinase thrombolysis on the cardiac function, coagulation, and fibrinolytic system in patients with AMI

Objective:To observe the effect of urokinase thrombolysis on the cardiac function, coagulation, and fibrinolytic system in patients with acute myocardial infarction (AMI). Methods: A total of 39 patients with AMI who were admitted in our hospital from March, 2016 to November, 2016 were included in the study and served as the observation group. The peripheral venous blood before and after thrombolysis was collected. The plasma NT-proBNP level, related coagulation factors, and fibrinolysis indicators were detected. The cardiac function before treatment was evaluated. A total of 30 healthy individuals who came for physical examinations were served as the control group for contrastive analysis.Results:The plasma NT-proBNP, Fg, and D-D levels before thrombolysis in the observation group were significantly higher than those in the control group, while PT, APTT, and TT in the observation group were significantly shortened. The plasma NT-proBNP and D-D levels 2-48 h after thrombolysis in the observation group were significantly elevated first and reduced later and reached the peak 4 h after treatment, while PT, APTT, and TT were significantly extended first and shortened later. The plasma Fg level was significantly reduced first and elevated later and reached the minimum 4 h after treatment. During the treatment process, in the observation group, 2 had mucocutaneous hemorrhage, 3 had nasal hemorrhage, and 1 had gingival bleeding, but no gastrointestinal bleeding or cerebral hemorrhage occurred.Conclusions:The thrombolytic therapy can effectively reduce the coagulation activity in patients with AMI, strengthen the fibrinolysis activity, and improve the cardiac function.

重度脑室内出血尿激酶溶栓单双管引流效率比较

目的：在尿激酶脑室内溶栓（ IVF）治疗下，比较重度脑室内出血（ IVH）患者在进行单管或双管脑室外引流（ EVD）时的引流效率。方法选择2010-01～2013-06符合纳入标准的47例重度IVH患者随机分为单侧脑室外引流组（单管引流组）和双侧脑室外引流组（双管引流组），各组患者均接受同样的脑室内尿激酶溶栓方案，剂量为2万U q 12 h，双管引流组左右侧药物注入选择为随机；记录并比较脑室内溶栓前及溶栓后1、3、5、7 d时的平均每日脑脊液（ CSF ）引流量、颅内压（ICP）、GCS评分及ICU监护时间、脑室外引流管放置时间（IVC放置时间）、IVH体积、Graeb评分、颅内感染率，并随访比较发病后6个月时的GOS评分及病死率等。结果两组患者的基线IVH体积、初次Graeb评分、GCS评分、年龄及性别例数比较差异均无统计学意义（ P＞0.05），具有可比性。两组ICU监护时间和IVC放置时间比较差异无统计学意义（P＞0．05），平均每日CSF引流量比较差异有统计学意义（ P＜0．05），双管引流组平均每日CSF引流量更多。两组溶栓前及溶栓后1、3、5、7 d时IVH体积下降程度比较差异有统计学意义，双管引流组优于单管引流组（P＜0．05），而Graeb评分、ICP、GCS两组比较差异无统计学意义（P＞0．05）；两组引流期间均未发现颅内感染。随访比较6个月时的GOS评分（t＝12．63，P＝0．000）和病死率（χ2＝7．57， P＝0．006）发现，双管引流组明显优于单管引流组。结论对于严重、体积大的IVH，相同IVF治疗条件下，放置双管EVD引流较单管清除血肿效率更高，并能改善预后和降低病死率，且不增加颅内感染率和延长IVC放置时间及ICU监护时间。

Linking inflammation and thrombosis:Role of C-reactive protein

C-reactive protein(CRP) is a biomarker of inflammation.Increased plasma levels of CRP are associated with an increased risk of myocardial infarction.However,the correlation between plasma CRP concentration and atherosclerotic plaque burden is poor.Based on these observations,it has been hypothesized that CRP increases the risk of myocardial infarction by promoting thrombosis.This article reviews available data that link enhanced CRP expression to increased risk of thrombosis,with a focus on the effects of CRP on hemostasis,platelet function,and fibrinolysis.Overall,the available data support the hypothesis that CRP is an important mechanistic link between inflammation and throm bosis.

Endovascular treatment of pulmonary embolism: Selective review of available techniques

Acute pulmonary embolism(PE) is the third most common cause of death in hospitalized patients. The development of sophisticated diagnostic and therapeutic modalities for PE, including endovascular therapy, affords a certain level of complexity to the treatment of patients with this important clinical entity. Furthermore, the lack of level I evidence for the safety and effectiveness of catheter directed therapy brings controversy to a promising treatment approach. In this review paper, we discuss the pathophysiology and clinical presentation of PE, review the medical and surgical treatment of the condition, and describe in detail the tools that are available for the endovascular therapy of PE, including mechanical thrombectomy, suction thrombectomy, and fibrinolytic therapy. We also review the literature available to date on these methods, and describe the function of the Pulmonary Embolism Response Team.

Hypofibrinogenemia Caused by Hemocoagulase Injection:A Retrospective Study on Clinical Laboratory Findings

Objective Hemocoagulase injection based on the venom of Agkistrodon halys Pallas is widely used in the treatment of hemorrhagic disorders.This study aimed to characterize the clinical laboratory findings of hemocoagulase-induced hypofibrinogenemia as the associated adverse reaction of hemocoagulase injection.Methods Wie retrospectively enrolled 27 in-patients who were treated with hemocoagulase injection for hemoptysis and developed hypofibrinogenemia during the period of January 1,2015 to March 31,2018.Clinical data were collected and investigated,including clinical manifestations,hemostatic and fibrinolytic parameters,dosage of hemocoagulase,the medication time,and the cryoprecipitate blood product infusion.Differences in fibrinogen,D-dimer,and fibrin/fibrinogen degradation products(FDP)before,during,and after the application of hemocoagulase injection were analyzed statistically.Results Plasma fibrinogen level during medication of hemocoagulase injection decreased significantly compared to that before the treatment(F=1.80,P<0.001),with the average decrease of 2.28 g/L(0.63-3.9 g/L).After withdrawal,fibrinogen level increased significantly compared to that during the medication(F=l.20,P<0.001),but was still lower than that before the medication(F=0.59,P=0.03).The D-dimer level and the FDP level after withdrawal decreased significantly compared to the levels during the medication(F=0.83,P=0.002;Wilcoxon-test,Z=-4.54,P<0.001).Spearman's correlation analyses did not find either fibrinogen change during-before the administration or FDP change after-during the administration was associated with the dosage of hemo coagulase(r=-0.17,P=0.40;r=-0.28,P=0.15;respectively)and the time of recovery from hypofibrinogenemia(r=-0.45,P=0.05;r=0.13,P=0.61;respectively).Conclusion Monitoring both clotting and fibrinolysis parameters is essential in the management of hemoptysis patients treated with hemocoagulase injection.Clinicians should be aware of hypofibrinogenemia and consider discontinuation of the administration of hemocoagulase whenever necessary.

D-dimer is useful in assessing the vulnerable blood in elderly patients with coronary disease

Background and objective The value of D-dimer in the risk stratification of patients with coronary artery disease(CAD) and the relationship between D-dimer and the diseased coronary arteries remains controversial or unclear,especially in the elderly.This study was to evaluate the usefulness of D-dimer as a biomarker in assessing the vulnerable blood in the elderly patients with coronary disease.Methods Sixty elderly (≥60 years old) male patients with suspected CAD were enrolled in this prospective study. Patients were divided into CAD group (n=41,10 with stable angina and 31 with unstable angina) and control group (n=19) according to their coronary angiography Results Clinical information including age,body mass index (BMI),smoking index,and the complications of primary hypertension or diabetes,and CAD family history was collected.Venous blood was sampled serially for the determination of total cholesterol,HDL cholesterol,LDL cholesterol,triglycerides,apoA1,apoB,glucose,uric acid,homocysteine (Hcy),hs-CRP,soluble thrombomodulin (sTM),and markers of fibrinolytic system and hypercoagulability,such as D-dimer,fibrinogen, etc.The extent of coronary atherosclerosis was assessed,using the Gensini scoring system on the basis of coronary angiography. Results Compared with the controls,the patients with CAD had significantly higher levels of D-dimer.D-dimer level was significantly correlated to age,hs-CRP,Hcy,and PAI-1.Patients with D-dimer levels in the top triplicate of D-dimer level had significantly higher prevalence of unstable angina compared with patients in the lowest triplicate (OR=4.8,Z=3.28,P=0.001).In an ordinal logistic regression,the OR value of developing more serious CAD augmented 3.1-fold with each increasing triplicate of D-dimer. Patients with unstable angina had a significantly higher level of D-dimer than the controls (P=0.005),and an increasing trend compared with patients with stable angina (P=0.059),whereas there was no difference between the patients with stable angina and the controls (P=0.885).D-dimer was significantly correlated with Gensini scores (r=0.3930,P=0.0019).Ordinal logistic regression showed that the OR value of increasing one or two triplicates of Genslni’s scores augmented 1.44-fold with each increasing triplicate of D-dimer (OR=2. 44,Z=2.87,P=0.004).Conclusions D-dimer may be a helpful biomarker in identifying the severity of vulnerable blood in elderly patients with CAD.

Efficacy and safety of single-bolus tenecteplase compared with front-loaded alteplase in Chinese patients with acute myocardial infarction

Background and Objective Previous study showed tenecteplase and alteplaxe were equovalent for 30-day mortality in the treatment of acute myocardial infarction. The purpose of this open-label,randomized,multi-center,angiographic trial was to assess the efficacy and safety of tenecteplase compared with alteplase in Chinese patients with acute myocardial infarction. Methods We recruited patients with acute ST-elevation myocardial infarction presenting within 6 hours of symptom onset from October,2002 to March,2004,in 5 hospitals in Beijing. After giving informed consent,patients were randomly assigned a single-bolus injection of tenecteplase(30-50 mg according to body weight) or front loaded alteplase(100 mg) ,and underwent coronary angiography at 90 min after starting the study drug. All patients received aspirin and heparin(target activated partial thromboplastin time 50-70 s) . The primary efficacy end point was the rate of TIMI grade 3 flow at 90 minutes. Other efficacy end points included TIMI grade 2/3 flow at 90 minutes. Safety end points included all stroke,intracranial hemorrhage(ICH) ,moderate/severe hemorrhage(except for ICH) ,all-cause mortality at 30-days,and major non-fatal cardiac events at 30 days. Results Overall 110 patients were eligible for statistical analysis,with 58 patients assigned to receive tenecteplase and 52 patients to alteplase. Tenecteplase produced a rate of TIMI grade 3 flow at 90 minutes after the start of thrombolysis(68.4%) similar to that of alteplase(66.7%,P=1.0) ;the rates of TIMI grade 2 or 3 were similar for patients treated with tenecteplase versus alteplase(89.5% versus 80.4%,respectively,P=0.278) . At 30 days,rates for all strokes were similar for the two groups(5.17% for tenecteplase and 1.92% for alteplase,P=0.62) ;rates of ICH were 3.45% and 1.92%(tenecteplase and rt-PA,P=1.00) respectively. The rate of moderate/severe hemorrhage was 8.62% with tenecteplase and 5.77% with alteplase(P=0.72) ;total mortality was almost identical in the two groups(13.8% versus 9.6%,respectively,P=0.565) while the rates of non-fatal cardiac complications were 10.35% and 11.54%(tenecteplase and alteplase,P=1.0) . Conclusions The efficacy of a single-bolus,weight-adjusted tenecteplase fibrinolytic regimen is equivalent to front-loaded alteplase in terms of the rates of TIMI grade 3 flow,and TIMI 2 or 3 flow,but the 30-day mortality and ICH in both groups was so high that the use of tenecteplase is not permitted in China. These negative safety results might be due to the high rate of percutaneous coronary intervention(PCI) and high dose of bolus heparin and suboptimal concomitant medical therapy during hospitalization,so further studies are needed to confirm the safety for tenecteplase in Chinese patients.

Targeted Thrombolytic Therapy

Venous and arterial thrombosis are closely related to many severe diseases, especially to cardiovascular and cerebrovasular disorders. Thrombolytic therapy has been proven to be an effective method to treat such disease, which decreased the mortality and morbidity greatly.

CLINICAL STUDY OF T-PA AND U-PA EXPRESSION IN PATIENTS WITH GASTROINTESTINAL CANCER

Objective: To study the changes of tissue-type plasminogen activator (t-PA), urokinase-type plasminogen activator (u-PA) expressions and fibrinolysis molecular markers in patients with gastrointestinal cancer in order to elucidate their clinical significance. Methods: The plasma levels of t-PA, u-PA, urokinase-type plasminogen activator receptor (u-PAR) and plasmin anti-plasmin complex (PAP) were measured by ELISA. t-PA and u-PA mRNAs were detected by Real-time RT-PCR. Results: The plasma levels of u-PA, u-PAR and PAP were elevated in gastrointestinal cancer patients, while u-PA was markedly elevated in patients with local infiltration, lymph node involvement or distal metastasis. U-PA mRNA was higher and t-PA was lower in gastrointestinal cancer compared to normal tissue. Conclusion: Hyperfibrinolysis is an important factor related with metastasis potential of gastrointestinal cancer. t-PA may be a character of well differentiated tissue.