Racial differences in responses to thrombolytic therapy with recombinant tissue-type plasminogen activator: Increased fibrin (ogen)olysis in blacks

David C. Sane, David C. Stump, Eric J. Topol, Kristina N. Sigmon, Walter K. Clair, Dean J. Kereiakes, Barry S. George, Marcus F. Stoddard, Eric R. Bates, Richard S. Stack, Robert M. Califf

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

To determine whether there are differences in responses to thrombolytic therapy in certain populations, the data for the Thrombolysis and Angioplasty in Myocardial Infarction (phase 1) study were analyzed for black and white patients. Baseline variables including risk factors and extent of coronary artery disease were similar in the 352 white and 24 black patients. The time from onset of chest pain to recombinant tissue-type plasminogen activator (rt-PA) therapy and rt-PA dosing regimens were the same in the two groups. The patency rate of the infarct-related artery at 90 minutes was 91% for blacks and was 72% for whites (p=0.051). Blacks displayed significantly lower nadir fibrinogen levels (0.57±0.62 versus 1.3±0.76 g/l, p<0.0001), greater Δ fibrinogen (baseline-nadir) (2.7±1.1 versus 1.7±1.1 g/l, p<0.0001), and increased peak levels of fibrin(ogen) degradation products (837±865 versus 245±475 μg/ml, p<0.0001). rt-PA antigen levels tended to be higher in blacks than in whites (2.8±2.2 versus 2.2±3.2 μg/ml [p=0.10] at the peak and 1.6±1.3 versus 0.99±1.4 μg/ml [p=0.06] at the end of the maintenance infusion). Major clinical outcomes including survival until time of hospital discharge (92% black versus 93% white, p=0.68) were not significantly different. However, despite undergoing fewer angioplasty procedures (25% versus 46.3%, p=0.047), blacks received more transfusions (58.8% versus 19.5% were administered ≥2 units packed erythrocytes, p=0.001). In conclusion, black patients have an apparent enhanced sensitivity to rt-PA, which is manifested by increased thrombolytic efficacy, a more pronounced systemic fibrinogen breakdown, and increased trans-fusions.

Original languageEnglish
Pages (from-to)170-175
Number of pages6
JournalCirculation
Volume83
Issue number1
StatePublished - Dec 1 1991
Externally publishedYes

Fingerprint

Thrombolytic Therapy
Tissue Plasminogen Activator
Fibrin
Fibrinogen
Angioplasty
Fibrin Fibrinogen Degradation Products
Chest Pain
Coronary Artery Disease
Arteries
Erythrocytes
Myocardial Infarction
Maintenance
Antigens
Survival
estropipate
Population
hydroquinone
Therapeutics

Keywords

  • Fibrinolytic therapy
  • Hemorrhagic complications
  • Plasminogen activator
  • Racial stocks
  • TAMI-1

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Sane, D. C., Stump, D. C., Topol, E. J., Sigmon, K. N., Clair, W. K., Kereiakes, D. J., ... Califf, R. M. (1991). Racial differences in responses to thrombolytic therapy with recombinant tissue-type plasminogen activator: Increased fibrin (ogen)olysis in blacks. Circulation, 83(1), 170-175.

Racial differences in responses to thrombolytic therapy with recombinant tissue-type plasminogen activator : Increased fibrin (ogen)olysis in blacks. / Sane, David C.; Stump, David C.; Topol, Eric J.; Sigmon, Kristina N.; Clair, Walter K.; Kereiakes, Dean J.; George, Barry S.; Stoddard, Marcus F.; Bates, Eric R.; Stack, Richard S.; Califf, Robert M.

In: Circulation, Vol. 83, No. 1, 01.12.1991, p. 170-175.

Research output: Contribution to journalArticle

Sane, DC, Stump, DC, Topol, EJ, Sigmon, KN, Clair, WK, Kereiakes, DJ, George, BS, Stoddard, MF, Bates, ER, Stack, RS & Califf, RM 1991, 'Racial differences in responses to thrombolytic therapy with recombinant tissue-type plasminogen activator: Increased fibrin (ogen)olysis in blacks', Circulation, vol. 83, no. 1, pp. 170-175.
Sane, David C. ; Stump, David C. ; Topol, Eric J. ; Sigmon, Kristina N. ; Clair, Walter K. ; Kereiakes, Dean J. ; George, Barry S. ; Stoddard, Marcus F. ; Bates, Eric R. ; Stack, Richard S. ; Califf, Robert M. / Racial differences in responses to thrombolytic therapy with recombinant tissue-type plasminogen activator : Increased fibrin (ogen)olysis in blacks. In: Circulation. 1991 ; Vol. 83, No. 1. pp. 170-175.
@article{d347592a6eed404a84d75de3c92fdc39,
title = "Racial differences in responses to thrombolytic therapy with recombinant tissue-type plasminogen activator: Increased fibrin (ogen)olysis in blacks",
abstract = "To determine whether there are differences in responses to thrombolytic therapy in certain populations, the data for the Thrombolysis and Angioplasty in Myocardial Infarction (phase 1) study were analyzed for black and white patients. Baseline variables including risk factors and extent of coronary artery disease were similar in the 352 white and 24 black patients. The time from onset of chest pain to recombinant tissue-type plasminogen activator (rt-PA) therapy and rt-PA dosing regimens were the same in the two groups. The patency rate of the infarct-related artery at 90 minutes was 91{\%} for blacks and was 72{\%} for whites (p=0.051). Blacks displayed significantly lower nadir fibrinogen levels (0.57±0.62 versus 1.3±0.76 g/l, p<0.0001), greater Δ fibrinogen (baseline-nadir) (2.7±1.1 versus 1.7±1.1 g/l, p<0.0001), and increased peak levels of fibrin(ogen) degradation products (837±865 versus 245±475 μg/ml, p<0.0001). rt-PA antigen levels tended to be higher in blacks than in whites (2.8±2.2 versus 2.2±3.2 μg/ml [p=0.10] at the peak and 1.6±1.3 versus 0.99±1.4 μg/ml [p=0.06] at the end of the maintenance infusion). Major clinical outcomes including survival until time of hospital discharge (92{\%} black versus 93{\%} white, p=0.68) were not significantly different. However, despite undergoing fewer angioplasty procedures (25{\%} versus 46.3{\%}, p=0.047), blacks received more transfusions (58.8{\%} versus 19.5{\%} were administered ≥2 units packed erythrocytes, p=0.001). In conclusion, black patients have an apparent enhanced sensitivity to rt-PA, which is manifested by increased thrombolytic efficacy, a more pronounced systemic fibrinogen breakdown, and increased trans-fusions.",
keywords = "Fibrinolytic therapy, Hemorrhagic complications, Plasminogen activator, Racial stocks, TAMI-1",
author = "Sane, {David C.} and Stump, {David C.} and Topol, {Eric J.} and Sigmon, {Kristina N.} and Clair, {Walter K.} and Kereiakes, {Dean J.} and George, {Barry S.} and Stoddard, {Marcus F.} and Bates, {Eric R.} and Stack, {Richard S.} and Califf, {Robert M.}",
year = "1991",
month = "12",
day = "1",
language = "English",
volume = "83",
pages = "170--175",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Racial differences in responses to thrombolytic therapy with recombinant tissue-type plasminogen activator

T2 - Increased fibrin (ogen)olysis in blacks

AU - Sane, David C.

AU - Stump, David C.

AU - Topol, Eric J.

AU - Sigmon, Kristina N.

AU - Clair, Walter K.

AU - Kereiakes, Dean J.

AU - George, Barry S.

AU - Stoddard, Marcus F.

AU - Bates, Eric R.

AU - Stack, Richard S.

AU - Califf, Robert M.

PY - 1991/12/1

Y1 - 1991/12/1

N2 - To determine whether there are differences in responses to thrombolytic therapy in certain populations, the data for the Thrombolysis and Angioplasty in Myocardial Infarction (phase 1) study were analyzed for black and white patients. Baseline variables including risk factors and extent of coronary artery disease were similar in the 352 white and 24 black patients. The time from onset of chest pain to recombinant tissue-type plasminogen activator (rt-PA) therapy and rt-PA dosing regimens were the same in the two groups. The patency rate of the infarct-related artery at 90 minutes was 91% for blacks and was 72% for whites (p=0.051). Blacks displayed significantly lower nadir fibrinogen levels (0.57±0.62 versus 1.3±0.76 g/l, p<0.0001), greater Δ fibrinogen (baseline-nadir) (2.7±1.1 versus 1.7±1.1 g/l, p<0.0001), and increased peak levels of fibrin(ogen) degradation products (837±865 versus 245±475 μg/ml, p<0.0001). rt-PA antigen levels tended to be higher in blacks than in whites (2.8±2.2 versus 2.2±3.2 μg/ml [p=0.10] at the peak and 1.6±1.3 versus 0.99±1.4 μg/ml [p=0.06] at the end of the maintenance infusion). Major clinical outcomes including survival until time of hospital discharge (92% black versus 93% white, p=0.68) were not significantly different. However, despite undergoing fewer angioplasty procedures (25% versus 46.3%, p=0.047), blacks received more transfusions (58.8% versus 19.5% were administered ≥2 units packed erythrocytes, p=0.001). In conclusion, black patients have an apparent enhanced sensitivity to rt-PA, which is manifested by increased thrombolytic efficacy, a more pronounced systemic fibrinogen breakdown, and increased trans-fusions.

AB - To determine whether there are differences in responses to thrombolytic therapy in certain populations, the data for the Thrombolysis and Angioplasty in Myocardial Infarction (phase 1) study were analyzed for black and white patients. Baseline variables including risk factors and extent of coronary artery disease were similar in the 352 white and 24 black patients. The time from onset of chest pain to recombinant tissue-type plasminogen activator (rt-PA) therapy and rt-PA dosing regimens were the same in the two groups. The patency rate of the infarct-related artery at 90 minutes was 91% for blacks and was 72% for whites (p=0.051). Blacks displayed significantly lower nadir fibrinogen levels (0.57±0.62 versus 1.3±0.76 g/l, p<0.0001), greater Δ fibrinogen (baseline-nadir) (2.7±1.1 versus 1.7±1.1 g/l, p<0.0001), and increased peak levels of fibrin(ogen) degradation products (837±865 versus 245±475 μg/ml, p<0.0001). rt-PA antigen levels tended to be higher in blacks than in whites (2.8±2.2 versus 2.2±3.2 μg/ml [p=0.10] at the peak and 1.6±1.3 versus 0.99±1.4 μg/ml [p=0.06] at the end of the maintenance infusion). Major clinical outcomes including survival until time of hospital discharge (92% black versus 93% white, p=0.68) were not significantly different. However, despite undergoing fewer angioplasty procedures (25% versus 46.3%, p=0.047), blacks received more transfusions (58.8% versus 19.5% were administered ≥2 units packed erythrocytes, p=0.001). In conclusion, black patients have an apparent enhanced sensitivity to rt-PA, which is manifested by increased thrombolytic efficacy, a more pronounced systemic fibrinogen breakdown, and increased trans-fusions.

KW - Fibrinolytic therapy

KW - Hemorrhagic complications

KW - Plasminogen activator

KW - Racial stocks

KW - TAMI-1

UR - http://www.scopus.com/inward/record.url?scp=0026025751&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0026025751&partnerID=8YFLogxK

M3 - Article

C2 - 1898641

AN - SCOPUS:0026025751

VL - 83

SP - 170

EP - 175

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 1

ER -