Skip to main content
Log in

Enalapril related changes in the fibrinolytic system in survivors of myocardial infarction

  • Short Communications
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Summary

Disturbances of the fibrinolytic system have been associated with cardiovascular disease and its risk factors. In the present study the effects of an ACE-inhibitor (enalapril) and a placebo on the fibrinolytic system have been compared. Eighty one survivors of acute myocardial infarction were randomised to treatment with enalapril or placebo. The mass concentrations and activity of tissue plasminogen activator (tPA) and plasminogen activator inhibitor (PAI-1) in plasma were measured three months after the infarction.

The enalapril group had a significantly lower level of tPA antigen compared to the placebo-treated group (9.2 and 10.6 respectively). There was no difference between the two groups in any of the other fibrinolytic variables.

We conclude that survivors of myocardial infarction treated with enalapril have a significantly lower concentration of tPA antigen than those treated with placebo. This may have a prognostic implication, as lower plasma concentrations of tPA antigen have been associated with better prognosis in patients with established coronary heart disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

References

  1. Hamsten A, Walldius G, Blombäck M, de Faire U, Dahlén G, Landon C, Wiman B (1987) Plasminogen activator inhibitor in plasma: risk factor for recurrent myocardial infarction. Lancet II: 3–8

    Google Scholar 

  2. Gram J, Jespersen J, Kluft C, Rijken CD (1987) On the usefulness of fibrinolytic variables in the characterization of a risk group for myocardial infarction. Acta Med Scand 221: 149–153

    Google Scholar 

  3. Munkvald S, Gram J, Jespersen J (1990) A depression of active tissue plasminogen activator in plasma characterizes patients with unstable angina pectoris who develop myocardial infarction. Eur Heart J 11: 525–528

    Google Scholar 

  4. Jansson J-H, Nilsson TK, Olofsson B-O (1991) Tissue plasminogen activator and other risk factors as predictors of cardiovascular events in patients with severe angina pectoris. Eur Heart J 12: 157–161

    Google Scholar 

  5. The CONSENSUS trial study group (1987) Effect of enalapril on mortality in severe congestive heart failure: results of the Co-operative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med 316: 1429–1435

    Google Scholar 

  6. The SOLVD Investigators (1991) Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med 325: 293–302

    Google Scholar 

  7. Cohn JN, Johnson G, Ziesche S, Cobb F, Francis G, Tristani F, Smith R, Dunkman WB, Loeb H, Wong M, Bhat G, Goldman S, Fletcher RD, Doherty J, Hughes CV, Carson P, Cintron G, Shabetai R, Haakenson C (1991) A comparison of enalapril with hydralazine-isorbide dinitrate in the treatment of chronic congestive heart failure. N Engl J Med 325: 303–310

    Google Scholar 

  8. Schrader J, Köstering H, Gröne H-j, Kirchertz EJ, Scheler F (1982) Effects of converting enzyme inhibitor captopril on blood coagulation and fibrinolysis in man. Klin Wochenschr 60: 687–690

    Google Scholar 

  9. Ts'ao C, Gardner DV, Galluzzo TS, Molteni A (1984) Effect of captopril, MK-421 and MK-422 on fibrinolysis determined by 3 “in vitro” assays. Arch Int Pharmacodyn Ther 267: 169–176

    Google Scholar 

  10. Jansson J-H, Teger-Nilsson A-C (1991) Drug effects on the fibrinolytic system. In: Nilsson TK, Boman K, Jansson J-H (eds) Clinical Aspects of Fibrinolysis. Almqvist & Wiksell, Stockholm, pp 111–129

    Google Scholar 

  11. Grimaudo V, Hauert J, Bachman F, Kruithof EKO (1988) Diurnal variation of the fibrinolytic system. Thromb Haemost 59: 495–499

    Google Scholar 

  12. R»nby M, Sundell B, Nilsson TK (1989) Blood collection in strong acidic citrate anticoagulant used in a study of dietary influence on basal tPA activity. Thromb Haemost 62: 917–922

    Google Scholar 

  13. Bergsdorf N, Nilsson T, Wallén P (1983) An enzyme-linked immunosorbent assay for tissue plasminogen activator applied to patients with thromboembolic disease. Thromb Haemost 50: 740–744

    Google Scholar 

  14. Chmielewska J, Wiman B (1986) Determination of tissue plasminogen activator and its “fast” inhibitor from plasma. Clin Chem 32: 482–485

    Google Scholar 

  15. Paramo JA, Colucci M, Collen D, van de Werf F (1985) Plasminogen activator inhibitor in the blood of patients with coronary artery disease. Br Med J 291: 573–574

    Google Scholar 

  16. Hamsten A, Wiman B, De Faire U, Blombäck M (1985) Increased plasma levels of a rapid inhibitor of tissue plasminogen activator in young survivors of myocardial infarction. N Engl J Med 313: 1557–1563

    Google Scholar 

  17. Olofsson B-O, Dahlén G, Nilsson TK (1989) Evidence for increased levels of plasminogen activator inhibitor and tissue plasminogen activator in plasma of patients with angiographically verified coronary artery disease. Eur Heart J 10: 77–82

    Google Scholar 

  18. Hellsten G, Boman K, Bjerle P, Blom P, Nilsson TK (1992) Increased plasminogen activator inhibitor and tissue plasminogen activator levels in subjects with electrocardiographic abnormality indicative of ischaemic heart disease: a cross-sectional study in Norsjö, Sweden. Eur Heart J 13: 57–60

    Google Scholar 

  19. Thorsen S, Philips M (1984) Isolation of tissue-type plasminogen activator-inhibitor complexes from human plasma. Biochim Biophys Acta 802: 111–118

    Google Scholar 

  20. Nilsson TK, Olofsson BO, Jansson JH (1992) Predictive value of tissue plasminogen activator mass concentration on long-term mortality in patients with angiographically verified coronary heart disease: a 7-year follow-up. (Abstract No 2383) American Heart Association, 65th Scientific Session, New Orleans. Circulation 86 [Suppl]: 1–598

    Google Scholar 

  21. Swedberg K for the CONSENSUS II Trial Study Group, Göteborg, Sweden (1991) Lack of beneficial effects on mortality by early intervention with enalapril in acute myocardial infarction. Circulation 84 [Suppl II]: 366–1457

    Google Scholar 

  22. Pfeffer MA, Braunwald E, Moyé LA, Basta L, Brown EJ, Cuddy TE, Davis BR, Geltman EM, Goldman S, Flaker GC, Klein M, Lamas GA, Packer M, Rouleau J, Rouleau JL, Rutherford J, Wertheimer JH, Hawkins M (1992) Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction-results of the Survival and Ventricular Enlargement Trial. N Engl J Med 327: 669–677

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jansson, J.H., Boman, K. & Nilsson, T.K. Enalapril related changes in the fibrinolytic system in survivors of myocardial infarction. Eur J Clin Pharmacol 44, 485–488 (1993). https://doi.org/10.1007/BF00315549

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00315549

Key words

Navigation