An increased thrombin generation is detectable for at least 1 week following elective percutaneous transluminal coronary angioplasty

Objective: The present prospective study was planned to investigate: (1) how long the early haemostatic changes after PTCA last and (2) if some coagulation and/or fibrinolytic parameters assessed during the first month after PTCA may be predictive of subsequent clinical recurrence.

Setting: Istituto di Clinica Medica Generale e Cardiologia, University of Florence, Florence, Italy.

Material and Methods: In 72 patients undergoing PTCA fibrinogen, F1+2, TAT, D-dimer and ELT were evaluated before the procedure (T1) and 2 (T2), 7 (T7) and 30 days (T30) after PTCA; PAI-1 and t-PA were assessed before PTCA and after 7 and 30 days. Follow-up angiography was performed only in patients with recurrence of ischaemia or positive ergometric tests.

Results: F1+2, TAT and fibrinogen were significantly increased at T2 (P<0.005); after a week, F1+2 and fibrinogen were still significantly higher in comparison to baseline values (P<0.005). At T30 these parameters showed significantly lower levels if compared to T1 (P<0.005). Plasma D-dimer concentration significantly increased at T2 and T7 (P<0.001), but no difference was found between baseline values and those at T30. PAI-1 activity significantly decreased at T7 (P<0.001), whereas it was similar to baseline at T30. No significant variations of t-PA levels were observed at the different times. Finally, ELT significantly increased at T2 (P<0.001), but at T7 and T30 the values were similar to baseline values. Clinical recurrence occurred in 19 patients. The values of various parameters investigated were not different at any time considered between the patients with and without subsequent clinical recurrence. Heparin treatment had no significant influence on thrombin generation at different times whereas it had marginal influences on fibrinogen, PAI-1 and t-PA antigen levels.

Conclusion: A number of alterations in haemostasis takes place and persists 2 and 7 days after elective PTCA and heparin treatment is not able to blunt clotting activation. The haemostatic parameters assessed during the first month after PTCA seem not to be predictive of subsequent clinical recurrence.