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Enhanced spontaneous thrombolysis: A new therapeutic challenge

  • Frontiers in Thrombocardiology
  • Published:
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Abstract

Spontaneous thrombolysis is an endogenous protective mechanism against lasting arterial thrombotic occlusion, which is implicated in the pathogenesis of myocardial infarction and acute coronary events. Novel therapies for coronary heart disease (CHD) targeting atherosclerosis and thrombosis, together with cardiovascular prevention programs targeting risk-factors and lifestyle provide evidence that CHD is preventable. Although reduced fibrinolytic activity is a recognized risk-factor for ischemic cardiovascular events, it has so far been neglected. Our knowledge of the fibrinolytic effect of drugs commonly used for CHD such as antiplatelet agents (aspirin, ticlopidine, clopidogrel), anti-diabetic biguanides (phenformin, metformin) or anti-hypertensive drugs is scanty and conflicting. This is mainly due to the lack of a global test of spontaneous thrombolysis, as opposed to fibrinolysis of plasma or whole blood, i.e. the assessment of various activators and inhibitors of the fibrinolytic system. A recently described technique allows the measurement of spontaneous thrombolysis, that is, lysis of an autologous platelet-rich thrombus in the absence of added plasminogen activators. Early results suggest that this test may have significant clinical potential both in identifying those at risk of fatal cardiac events and in finding new therapeutic avenues or lifestyles to improve spontaneous thrombolytic activity.

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Abbreviations

AMI:

acute myocardial infarction

TAFI:

thrombin activatable fibrinolysis inhibitor

t-PA:

tissue-type plasminogen activator

u–PA:

urokinase-type plasminogen activator

PAI:

plasminogen activator inhibitor

ELT:

Euglobulin Lysis Time

FDP:

fibrin degradation product

Alpha 2–AP:

alpha 2 antiplasmin

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Authors and Affiliations

  1. St. Bartholomew’s Hospital Medical School, London, UK

    I. B. Kovacs MD, PhD, FRCPath (Formerly Senior Lecturer and Consultant, Head of Thrombosis Unit)

  2. Royal Brompton & Harefield NHS Trust, Harefield, UK

    D. A. Gorog MD, PhD (MRCP Consultant Cardiologist)

  3. Faculty of Nutrition, Kobe Gakuin University, Kobe, Japan

    J. Yamamoto PhD (FRCPath Professor of Physiology)

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  1. I. B. Kovacs MD, PhD, FRCPath
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  2. D. A. Gorog MD, PhD
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  3. J. Yamamoto PhD
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Correspondence to J. Yamamoto PhD.

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Kovacs, I.B., Gorog, D.A. & Yamamoto, J. Enhanced spontaneous thrombolysis: A new therapeutic challenge. J Thromb Thrombolysis 21, 221–227 (2006). https://doi.org/10.1007/s11239-006-6579-0

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