Details

Autor(en) / Beteiligte

• Wright, Robert A.
• Flapan, Andrew D.
• Alberti, K.George M.M.
• Ludlam, Christopher A.
• Fox, Keith A.A.

Titel

Effects of captopril therapy on endogenous fibrinolysis in men with recent, uncomplicated myocardial infarction

Ist Teil von

• Journal of the American College of Cardiology, 1994-07, Vol.24 (1), p.67-73

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

1994

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• Objectives. This study investigated the effects of captopril therapy on endogenous fibrinolysis in men with recent, uncomplicated myocardial infarction. Background. Angiotensin-converting enzyme inhibitors reduce the incidence of acute coronary syndromes in patients with mild left ventricular dysfunction after myocardial infarction. Abnormal endogenous fibrinolysis, reflected in increased levels of endogenous tissue-type plasminogen activator (t-PA) antigen and plasminogen activator inhibitor type 1 activity, is associated with an increased risk of myocardial infarction in patients with ischemic heart disease. Methods. In a randomized, double-blind crossover study beginning 8 weeks after uncomplicated myocardial infarction, patients received 4 weeks of placebo and 4 weeks of captopril (75 mg daily) therapy. At the end of each treatment period, we measured t-PA antigen and plasminogen activator inhibitor type 1 antigen and activity. Results. Median values in the 15 patients after placebo and in 12 normal men matched for age and body mass index were, respectively, t-PA antigen 16.0 versus 9.5 ng/ml (p = 0.001), plasminogen activator inhibitor type 1 antigen 17.3 versus 8.6 ng/ml (p = 0.29) and plasminogen activator inhibitor type 1 activity 13.2 versus 6.3 AU/ml (p = 0.04). After 4 weeks of treatment with captopril in the 15 patients, the estimated (95% confidence interval) median reduction in t-PA antigen was 7.3 ng/ml (−4.6 to −10.3 ng/ml, p = 0.001), in plasminogen activator inhibitor type 1 antigen 3.1 ng/ml (+1.5 to −8.4 ng/ml, p = 0.17) and in plasminogen activator inhibitor type 1 activity −2.2 AU/ml (−1.0 to −4.3 AU/ml, p = 0.02). Conclusions. Treatment with captopril after uncomplicated myocardial infarction is associated with a significant decrease in elevated levels of t-PA antigen and plasminogen activator inhibitor type 1 activity. This may help to explain the reduction in risk of coronary thrombosis associated with the use of angiotensin-converting enzyme inhibitors.