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| Year : 1981 | Volume
: 27
| Issue : 2 | Page : 105-8 |
Fibrinolytic activity in coronary heart disease.
Rani MM, Nath KK, Mehrotra TN, Mishra SD
How to cite this article:
Rani M M, Nath K K, Mehrotra T N, Mishra S D. Fibrinolytic activity in coronary heart disease. J Postgrad Med 1981;27:105 |
Literature available on fibrinolytic activity in coronary heart disease presents conflicting reports. Some investigators[3], [4], [6], [8] have reported a greater incidence of low fibrinolytic activity in acute myocardial infarction while others[5], [7] could not show any effect on fibrinolytic activity in coronary heart disease. Therefore investigations of the relationship between fibrinolytic activity and coronary heart disease have been incomplete and inconclusive and require further confirmation. Present study was undertaken to find out the fibrinolytic activity in patients of coronary heart disease.
The study was carried out in two groups. Group A comprised of 25 healthy adults or patients suffering from diseases not usually regarded as affecting the fibrinolytic activity, serving as controls. Group B consisted of 83 cases of coronary heart disease (WHO criteria, 1961) admitted in the Medical Wards of S.V.B.P. Hospital, Meerut. Particular care was taken to exclude any other condition which might affect the fibrinolytic activity e.g. diabetes mellitus, renal disorders, cerebral thrombosis, neoplastic disease, hepatic disorders and rheumatoid arthritis. Smoking and tobacco were not allowed and physical activity, diet and time of meals were kept uniform during the study in both the groups.
Group B was further divided into two subgroups. Group B1 comprising of 83 cases of myocardial infarction (old or recent) and Group B3 consisted of 50 cases of coronary heart disease other than myocardial infarction (angina, acute coronary insufficiency). Of the 33 cases of myocardial infarction 13 were having complications like heart failure, arrhythmias, shock; the rest 20 cases were without complications; in group B2 only 8 cases were having complications.
Fibrinolytic activity was measured as Euglobulin clot lysis time (E.L.T.) (Buckell, 1958)2 in all cases on the 1st day, 2nd day, 3rd day and then weekly for 3 weeks in addition to E.C.G. and other routine biochemical tests."Z" test was applied to determine the level of significance of results and p was calculated from these Z values.
Mean age for both the groups was 53 years and 53.8 years respectively and male to female ratio was 5:1. Fibrinolytic activity was found to be independent of the age and sex.
Mean E.L.T. in the control group was found to be 156.92 + 48.3 minutes while in group B it was 175.41 + 66.1 minutes [Table - 1] which was more than group A but statistically non-significant.
There was no significant change in the fibrinolytic activity even on the 2nd day, 3rd day and upto 3 weeks of infarction [Table - 2].
An attempt was also made to evaluate the difference in results between cases of myocardial infarction with complications and without complications. It was found that there was statistically significant fall in the fibrinolytic activity (Rise in. ELT) in cases of myocardial infarction with complications but not in cases of MI without complications [Table - 3].
When results of Group B2 were compared with controls, it was found that there was no significant fall in the fibrinolytic activity [Table - 4].
Various risk factors have been blamed for causation of coronary heart disease. Decreased fibrinolytic activity has been thought to be one of the aetiological factors. Opinions about fibrinolytic activity in coronary heart disease have been conflicting. Generally a marked decrease in fibrinolytic activity has been reported in acute myocardial infarction[1], [3], [4], [6], [8] while others[9] have shown initial increase for a few hours and then a subsequent fall in the fibrinolytic activity in cases of myocardial infarction. In our study however there was no significant fall in the fibrinolytic activity in coronary heart disease either on the same day or even upto 3 weeks except in cases of myocardial infarction with complications in which fibrinolytic activity was significantly low on the 1st day and came to control level from 2nd day onwards. This finding makes us to think that the cases of coronary heart disease in whom fibrinolytic activity is significantly low, are more likely to develop complications. However this would require further confirmation with other controlled studies.
| 1. | Bick, R. L., Bishop, R. C. and Shanbrom, E. S.: Fibrinolytic activity in acute myocardial infarction. Amer. J. Clin. Path., 57: 359-363, 1972.  |
| 2. | Buckell, M.: Effect of citrate on euglobulin methods of, estimating fibrinolytic activity. J. Clin. Path., 11: 403-405, 1958. |
| 3. | Chakrabarti, R., Hocking, E., Fearnley, G., Mann, R. D., Atwell, T. N. and Jackson, D.: Fibrinolytic activity and coronary heart disease. Lancet, 1: 967-990, 1968. |
| 4. | Hume, R.: Fibrinolysis in myocardial infarction. Brit. Heart J., 20: 15-20, 1958. |
| 5. | Katz, A. M., McDonald, L., Davis, B. and Edgill, M.: Fibrinolysis and blood coagulation in ischaemic heart disease. Lancet, 1: 801-802, 1963. |
| 6. | Lackner, H. and Merskey, S.: Variation in fibrinolytic activity after acute myocardial infarction and after anticoagulants. Brit. J. Haematol., 6: 402-413, 1960. |
| 7. | Merskey, S., Gordon, H., Lackner, H., Schrire, V., Kaplon, B. J . , Sougin-Mibashen, R. Nossel H. L. and Moodie, A.: Blood coagulation and fibrinolysis in relation to coronary artery disease. Brit. Med. J., 1: 219-227, 1960. |
| 8. | Mittal, M. M., Gupta, N. N. and Mehrotra, R. M. L.: Study of plasma fibrinogen and fibrinolytic activity in myocardial infarction. J. Assoc. Phys. India, 18: 795-801, 1970. |
| 9. | Ogston, D. and Fullerton, H. W.: Plasma fibrinolytic activity following recent myocardial and cerebral infarction. Lancet, 2: 99-101, 1965. |
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