Relationship between soluble fibrin and X-oligomer following elective PTCA

Background. Percutaneous transluminal coronary angioplasty (PTCA) involves traumatic rupture of atheromatous tissue in order to relieve obstructive coronary artery lesions. As such, it would be expected that there is a degree of activation of both the coagulation and fibrinolytic systems following the procedure. Methods. Soluble fibrin (an early product of coagulation), and Xoligomer (an early product of fibrinolysis) were measured by ELISA in 21 patients (ages 48-72 years - mean 62.6) undergoing elective PTCA for stable angina pectoris. Samples were taken prior to PTCA (and administration of 10,000 iu of heparin) and at 15 minutes, 1, 2 and 24 hours. Results. Our data from several hundred samples from a similar population base suggest a normal range of <5 U/mL for soluble fibrin. Soluble fibrin was actually elevated in this patient population prior to intervention (mean 19.1 U/mL) and fell significantly (p=0.01) following PTCA (mean 8.5 U/mL). Levels remained supressed until 24 hours when levels tended to be slightly elevated (mean 24.1 U/mL). Xoligomer remained within our normal range (<300 ng/mL) throughout the sampling period, but fell immediately following PTCA (p=0.001, pre vs. 15 minutes), and only returned to pre-treatment levels at 24 hours. Conclusions. An unexpected finding was elevation in soluble fibrin levels prior to intervention compared to controls. This suggests that individuals with stable angina pectoris exhibit a degree of coagulation activity. Initial falls in soluble fibrin probably reflects efficacy of intravenous heparin which is routinely given to all patients prior to PTCA.