Lack of association between raised serum Lp(a) concentration and unsuccessful thrombolysis after acute myocardial infarction

Lipoprotein (a): truly a direct prothrombotic factor in cardiovascular disease?

“…In the early 1990s, this question was addressed in studies of different thrombolytic agents in acute MI, most frequently derivatives of tPA, such as alteplase. Surprisingly, these studies uniformly reported that Lp(a) concentrations did not predict the success of thrombolysis in this setting (112)(113)(114)(115)(116). Given the strong in vitro findings that apo(a) can interfere with tPA-mediated fibrinolysis and plasminogen activation (see above), it is fair to ask why these clinical results may have been observed.…”

Serum lipoprotein(a) level in relation to severity of coronary artery disease and coronary artery patency in acute myocardial infarction

“…[20][21][22] Moreover, the Lp(a) level did not correlate with changes in infarct-related artery patency during follow-up. Two of our patients treated conservatively had TIMI flow grades of 0 and 1 in their infarct-related arteries and low serum Lp(a) levels.…”

“…17,18 The level of Lp(a) is higher in patients with MI not given thrombolytic therapy if the infarct-related artery is not recanalized spontaneously, 19 although no association between raised serum Lp(a) concentrations and unsuccessful thrombolysis has been observed. [20][21][22][23] However, the Lp(a) level is related to thrombin generation and spontaneous intermittent coronary occlusion in patients with acute MI. 24 In the present study, relationships between Lp(a) level and angiographic severity of coronary artery disease and infarct-related artery patency were studied in patients with acute MI.…”

Consideration and Application of Lipoprotein(a) in the Risk Assessment of Atherosclerotic Cardiovascular Disease Risk in Adults

“… 46 Further, elevated Lp(a) levels have not been found to reduce the efficacy of thrombolytic therapy, although these findings were reported only in a series of small studies. 47 , 48 , 49 , 50 , 51 , 52 Conversely, studies with expression of apo(a) in transgenic mice did result in reduced fibrinolysis. 53 These conflicting data seem to suggest a prothrombotic effect of Lp(a) that extends beyond its antifibrinolytic properties.…”