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[Non ST elevation acute coronary syndrome. Parameters of fibrinolysis during short term use of ticlopidine or clopidogrel]

Author(s): Slavina NN, Averkov OV, Dobrovol'skii AB, Gratsianskii NA

Affiliation(s): Tsentr ateroskleroza NII fiziko-khimicheskoi meditsiny, Moskva.

Publication date & source: 2003, Kardiologiia., 43(7):4-11.

Publication type: Clinical Trial; Randomized Controlled Trial

Whether thienopyridines (ticlopidine or clopidogrel) produce similar effects on fibrinolysis in patients with non ST elevation acute coronary syndrome (NSTEACS) was not well elucidated. AIM: To study changes of parameters of fibrinolysis during short term use of ticlopidine and clopidogrel in NSTEACS patients treated with aspirin and antithrombin. MATERIAL: Patients with NSTEACS treated with aspirin and unfractionated heparin (UFH, n=37) or enoxaparin (n=19). METHODS: The UFH treated patients were randomized to ticlopidine (1000 mg/day for 2 and then 500 mg/day for 5 days, n=19) or no ticlopidine (n=18). Enoxaparin treated patients were randomized to either clopidogrel (300 mg/day for 1 and then 75 mg/day for 6 days, n=10) or no clopidogrel (n=9). Levels of tissue plasminogen activator (TPA) antigen, D-dimer, and activity of plasminogen activator inhibitor (PAI) were measured before and in 24 hours, 3, 7, 14 days after randomization. RESULTS: At baseline values of parameters studied were similar in each pair (thienopiridine - control) of patients groups. Compared with their controls ticlopidine treated patients on day 7 had less pronounced lowering of PAI activity (13.6 and 8.2 U/l, p<0.05) and lower D-dimer concentration (515 and 770 ng/ml, respectively, p<0.05). Clopidogrel treated patients on days 3, 7 and 14 had higher levels of TPA both compared with controls (25.7 and 20.2, p<0.05; 26.5 and 12.9, p<0.01; 24.6 and 15.7 ng/ml, p<0.01; respectively) and baseline. D-dimer levels in these patients on same time points were also higher than in controls (969 and 702, p<0.05, 970 and 575, p<0.01, 806 and 484 ng/ml, p<0.01, respectively). CONCLUSION: Compared with controls the use of ticlopidine in patients with NSTEACS treated with aspirin and UFH was associated with less pronounced lowering of PAI activity and lower level of D-dimer. This could be interpreted as consequence of inhibition of fibrinolysis. The use of clopidogrel in similar patients treated with aspirin and enoxaparin was associated with elevated levels of TPA and D-dimer what presumably reflected augmentation of fibrinolytic activity.

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