Fibrinopeptide A (FPA) is a very sensitive marker of fibrin generation in vivo. Because an imbalance between thrombogenic and thrombolytic forces may be responsible for the failure to recanalize and for reocclusion of coronary arteries, such a marker could be of eminent value during thrombolytic treatment of acute myocardial infarction. Thirty-four consecutive patients with acute myocardial infarction (peak creatine kinase level, 1,869±+1,543 IU/l) were treated with 100 mg recombinant tissue-type plasminogen activator (rt-PA) 3.1±1.1 hours after onset of chest pain. Angiography 12.5+±6.1 days later revealed an 81% patency rate of the infarct-related vessel. FPA plasma levels (normal, 1.9±0.5 ng/ml) were 34±46 ng/ml on admission and 93+86 ng/ml (538 ±674% with respect to each patient's admission level) after 90 minutes of rt-PA infusion (p <0.01). In patients without evidence of reocclusion (including three primary failures), FPA levels fell under continuous heparin infusion to 6.7 +9.7 ng/ml (24+33%,p

No abstract