The Influence To The Activation Of Systemic Fibrinolysis In Patients With ST Elevation Myocardial Infarction Which Treated By Early Use Of Tirofiban

BackgroundAcut ST-segment elevation myocardial infarction(STEMI) is one of the emergency and severe case which could threaten human's health and life safty. The pathological basis for STEMI is unstable atherosclerotic plaque in coronary artery,which could be take the plateletes activation and aggregate become to thrombus by it's damage or rupture. The thrombus could blocking the blood in coronary artery so that myocardiums became necrosis. So the anti-platelet therapy become the basical and key point in early stage in STEMI.In these years,gradual advance in the anti-platelet therapy have been made,one of these progrestion is the discovertion that the final pathway of platelet aggregation is glycoproteinⅡb/Ⅲa receptor of platelet combined with the fibrinogens and the antagonist of glycoproteinⅡb/Ⅲa receptor is the best and strongest medicine which be used to blok the final pathway.this kind medicines become key in blok platelet aggregation.Since, a great deal study about the antagonist of glycoproteinⅡb/Ⅲa receptor using in therapy of STEMI have been taken.these studys involved in the antagonist of glycoproteinⅡb/Ⅲa receptor's usage,dosage and the best time for using.addition,the interactions when it been using combined other medicines,the MACE in STEMI who was used it,the drug adverse effect,and so on. But,we discovered the STEMI patients' reperfusion rate in criminal coronary artery are higher in percutaneous coronary intervention who was used the antagonist of glycoproteinⅡb/Ⅲa receptor in its early period and their rate of nonreflow are lower,even when the nonreflow has occurrenced in percutaneous coronary intervention,we give the antagonist of glycoproteinⅡb/Ⅲa receptor(tirofiban) intime,it can be discovered that nonreflow becomes lighten.We know,the thrombus in STEMI coronary artery are red thrombus include much fibrinogens,so,how can we explain those events we have seen by the function of the antagonist of glycoproteinⅡb/Ⅲa receptor's blok platelet aggregation? When all is said and done,the red thrombus been reduced base on the depolymerization of fibrinogens.Up to now, we have not find some study about tirofiban inflount the activation of fibrinolytic system,so we want to explore it through some review about STEMI patients.ObjectiveResearch the inflounce to the activation of fibrinolytic system in STEMI patients who was treated by tirofiban early through the review to the fibrinolytic system's activation's makers in patients treated by tirofiban or not.Objects and methodsObjects:58 patients from the Second Affiliated hospital of Zhengzhou University,who suffered from acute ST-segment elevation myocardial infarction no longer about 12 hours during July,2009 and December,2010. Inclusion criteria:1 Chest pain contin beyond 30 minute,and can not release by nitroglycerine tablet.2 There must be more than two limb leads or chest leads'ST-segment elevation greater than or equal to 2mm or include left bundlebranch block(LBBB) in 12-lead ECG;3The CK-MB/cTnl elevated must more than 3 times of their normal;4Have not used anticoagulant therapy(heparin or LMWH) and tirofiban before they went to hospital; Exclusion criteria:1UA,NSTEMI;2attack time more than 12 hours;3Have undgoing major operations,trauma,stroke,hemorrhagic disease;4Antiplatelet drug allergy;5 Have been used anticoagulant therapy(heparin or LMWH) and tirofiban before they went to hospital.Methods:These patients were randomly divided into control group and treatment group,there were 32 patients in control group,26 patients in treatment group.All patients in two groups have aspirin 300mg and clopidogrel 300mg oral polio when they arrive at emergency room.and have aspirin 100mg and clopidogrel 75mg oral polio and injected LMWH under the skin 2 times every day follow this in hospital.In addition to, the treatment group must been intravenous injects tirofiban according to 10μg/Kg standard immediately when they arrive at emergency room. And subsequently been give 0.15μg/Kg/min vein input continue 36 hours.Main outcome Measures and Collecting Techniques:Two groups have been extraction of upper limb vein at befor therapy,treating 12 hours,treating 36 hours and therapy 7 days.when extraction of upper limb vein determine t-PA,PAI-1 content by ELISA at fast and determine FDP concentration by Latex aggregation method.Data processing:All data processed by SPSS 17.0.ResultComparison of clinical data of two groups:There were no significant difference in ages,gender tatios,basic diseases and time using in arrive at hospital,bettwen two groups. There have comparability.Comparison of parameters of fibrinolytic system of two groups:There were no significant difference at t-PA,PAI-1 and FDP content in two groups, t-PA,FDP content continually rasing from the tirofiban used to treating 12 hours,36 hours in treatment group and PAI-1 content continually down at same times.these parameters in control group have no significant difference change; At therapy 7 day, there were no significant difference at t-PA,PAI-1 and FDP content in two groups and the same compared with befor therapy.ConclusionIt could enhanced the activation of fibrinolytic system by using tirofiban in vein in STEMI patients early, and enhanced activation of fibrinolytic depolymerize the blood clots fibrin nets in coronary artery. So the thrombus is depolymerized. the coronary artery been reperfusion.