thromboxane-a2 and Angina-Pectoris

Acetylsalicylic acid has an antithrombotic effect by inhibition of thromboxane A2 synthesis in platelets. Thromboxane A2 is a potent stimulator of platelet aggregation and vasoconstriction and synthesis may be completely inhibited by a single oral dose of 150 mg acetylsalicylic acid or an intravenous dose of 100 mg. A daily maintenance dose of 75 mg acetylsalicylic acid is sufficient to effectively inhibit thromboxane A2 synthesis in long-term treatment. Acetylsalicylic acid therapy reduces acute myocardial infarction and sudden death in patients with stable angina pectoris and the drug is equally effective in patients with symptomatic and 'silent' angina pectoris. Early intervention with acetylsalicylic acid in patients with unstable angina pectoris reduces the risk of acute myocardial infarction and death. In patients with acute myocardial infarction, acute therapy with acetylsalicylic acid significantly reduces mortality both in monotherapy and in combination with thrombolytics. In the secondary prophylaxis following acute myocardial infarction, acetylsalicylic acid reduces the incidence of reinfarction and coronary death. Treatment of 100 patients with acute coronary syndrome (unstable angina pectoris or acute myocardial infarction) for 2 years may hinder the development of 3-4 fatal and 4 non-fatal vascular events. The risk of gastrointestinal side-effects and bleeding during acetylsalicylic acid therapy is dose-dependent and the incidence is low with a daily dose of 75-150 mg.

Topics: Administration, Oral; Angina Pectoris; Antithrombins; Aspirin; Humans; Injections, Intravenous; Male; Myocardial Infarction; Thromboxane A2

Topics: Angina Pectoris; Angina, Unstable; Animals; Coronary Vessels; Humans; Leukocytes; Platelet Activation; Thromboxane A2; Vasoconstriction

Topics: Angina Pectoris; Angina, Unstable; Arachidonic Acid; Arachidonic Acids; Coronary Disease; Epoprostenol; Humans; Myocardium; Platelet Aggregation; Thromboxane A2

Thromboxane has characteristics that signify potential importance in cardiovascular disease states. In models developed for studying thrombotic sudden death, thromboxane appears to be an important mediator. Thus, in arachidonic acid-induced sudden death, agents that either inhibit thromboxane generation or block thromboxane receptor activation prevent the occurrence of thrombotic death. Thromboxane mimetics are also useful in modeling sudden death; when injected i.v., these compounds elicit effects similar to those obtained with arachidonic acid. In this case, however, pretreatment with cyclooxygenase or thromboxane synthetase inhibitors confers no protection, whereas the thromboxane receptor antagonist retains its efficacy. Other factors that affect susceptibility to experimental sudden death include gender, species, and endocrine status. Thrombotic sudden death models have now been used to test, in vivo, the in vitro antiplatelet aggregatory effect of calcium-channel blockers. The data suggest that dihydropyridine agents such as nifedipine and nisoldipine are protective against thrombosis, whereas verapamil may have little such activity. Furthermore, sudden death induced by a variety of thrombotic challenges is prevented by pretreatment with nifedipine. The thrombotic sudden death models currently employed are useful for the in vivo study of the thrombotic process and for the evaluation of agents with potentially thrombotic or antithrombotic properties.

Topics: Angina Pectoris; Animals; Arachidonic Acid; Arachidonic Acids; Calcium Channel Blockers; Castration; Death; Estrogens; Fatty Acids, Monounsaturated; Fatty Acids, Unsaturated; Female; Glucocorticoids; Humans; Male; Methacrylates; Prostaglandin Endoperoxides, Synthetic; Sex Factors; Testosterone; Thrombosis; Thromboxane A2; Thromboxane B2; Thromboxanes

Topics: Angina Pectoris; Animals; Arterioles; Blood Platelets; Blood Pressure; Coronary Circulation; Coronary Disease; Coronary Vessels; Epoprostenol; Humans; Hyperlipidemias; Microcirculation; Platelet Aggregation; Rheology; Spasm; Stress, Physiological; Stress, Psychological; Thromboxane A2; Vascular Resistance; Vasoconstriction

Topics: Angina Pectoris; Animals; Arachidonic Acids; Coronary Circulation; Coronary Disease; Coronary Vessels; Disease Models, Animal; Epoprostenol; Humans; Leukocytes; Lipoxygenase; Myocardial Infarction; Prostaglandin-Endoperoxide Synthases; Prostaglandins; Thromboxane A2

Topics: Angina Pectoris; Angina Pectoris, Variant; Coronary Disease; Coronary Vasospasm; Humans; Prostanoic Acids; Stress, Physiological; Thromboxane A2; Vasoconstriction; Vasodilation

Topics: Angina Pectoris; Angina Pectoris, Variant; Blood Platelets; Coronary Disease; Death, Sudden; Diet; Epoprostenol; Humans; Muscle, Smooth, Vascular; Myocardial Infarction; Platelet Aggregation; Risk; Smoking; Thromboxane A2

Topics: Adenosine Diphosphate; Adult; Aged; Angina Pectoris; Aspirin; Blood Platelets; Cerebrovascular Disorders; Coronary Disease; Epinephrine; Epoprostenol; Female; Humans; Male; Middle Aged; Myocardial Infarction; Platelet Adhesiveness; Platelet Aggregation; Propranolol; Thromboxane A2

The role of thromboxane A2 (TxA2) in unstable angina has not yet been defined. TxA2 receptor antagonists may be of value in studying this role.. To investigate whether TxA2 has a pathogenetic effect on the occurrence of myocardial ischemia and from what source TxA2 originates, we studied TxA2 formation by unstimulated monocytes from patients with unstable angina (n = 40), stable effort angina (n = 20), and controls (n = 20). We also compared the effects of picotamide (1200 mg/day), a TxA2-synthase inhibitor and TxA2-receptor antagonist, with those of aspirin (325 mg/day) on myocardial ischemia and TxA2 formation by monocytes and platelets. The double-blind randomized study was performed on patients with unstable angina on continuous Holter monitoring.. In the presence of autologous lymphocytes, unstimulated monocytes from patients with unstable angina formed significantly (P < 0.001) more TxA2 than those from controls or from patients with effort angina. Although TxA2 formation by circulating monocytes and platelets was inhibited to a greater degree by aspirin than by picotamide (88 +/- 6 and 98 +/- 2%, respectively, versus 65 +/- 2 and 74 +/- 1%, P < 0.001), aspirin failed to affect the occurrence of myocardial ischemia whereas picotamide significantly (P < 0.001) reduced the number of anginal attacks (84.8%), silent ischemic episodes (64.2%), and overall duration of ischemia (69.8%), in comparison to the run-in period.. These results indicate that TxA2 formed by monocytes contributes to the pathogenesis of myocardial ischemia in unstable angina. TxA2 formation occurs mainly in extravascular spaces, probably within the coronary vascular wall. Picotamide appears to control myocardial ischemia effectively in patients with unstable angina.

Topics: Aged; Angina Pectoris; Angina, Unstable; Aspirin; Double-Blind Method; Female; Follow-Up Studies; Humans; Leukocytes, Mononuclear; Lymphocytes; Male; Middle Aged; Myocardial Ischemia; Phthalic Acids; Placebos; Platelet Aggregation Inhibitors; Prospective Studies; Thromboxane A2

Episodic platelet activation has been shown to occur in unstable angina, and aspirin should have an important therapeutic role in the management of these patients. The response to aspirin alone or to aspirin in combination with vasodilators such as heparin and beta-blockers has been assessed in 41 patients with unstable angina. Therapy was added sequentially in the event of recurrence of transient myocardial ischemia. Patients were randomly assigned to two groups. Group 1 (21 patients) received an intravenous infusion of isosorbide dinitrate and oral diltiazem, and group 2 (20 patients) received intravenous aspirin (60 mg the first day and 20 mg on successive days). This dose of aspirin reduced serum thromboxane B2 from 160 +/- 88 ng/ml (mean +/- SD) to undetectable values (less than 6 ng/ml, p less than 0.01). If episodes of ischemic ST segment shift continued, the therapy of group 1 was added to that of group 2 or vice versa; if further ST segment changes were documented, intravenous heparin and oral beta-blockers were added; if episodes of myocardial ischemia persisted, urgent coronary arteriography and myocardial revascularization were performed. Nine patients in group 1 and six in group 2 (p = 0.8) had no further episodes of myocardial ischemia on their initial therapy; 12 additional patients had no further episodes when taking combined therapy of aspirin and vasodilators. Thus, the administration of aspirin alone was not superior to coronary dilators; 30% of all patients continued to have episodes of myocardial ischemia or had a myocardial infarction develop when heparin and beta-blockers were added. Myocardial infarction occurred in one patient on vasodilator therapy alone, in two on combined therapy, and in two on full therapy. These results suggest that in some patients, the stimulus to coronary thrombosis and vasoconstriction occasionally becomes so strong that it cannot be inhibited by certain antagonist drugs. The unstable tendency to continuation of ischemia or evolution to myocardial infarction is not related to the severity of the persisting stenosis. Those patients not promptly responding to combined therapy immediately from admission should have early coronary angiography and aggressive treatment.

Topics: Angina Pectoris; Angina, Unstable; Aspirin; Diltiazem; Drug Therapy, Combination; Electrocardiography; Exercise Test; Female; Humans; Isosorbide Dinitrate; Male; Middle Aged; Platelet Aggregation; Randomized Controlled Trials as Topic; Thromboxane A2; Thromboxane B2

Thromboxane A2 (TxA2), an arachidonic acid metabolite causing vasoconstriction and platelet aggregation, is a putative mediator of coronary-artery vasospasm. To determine whether platelet-released TxA2 causes coronary arterial vasospasm, we measured plasma thromboxane B2 (TxB2, the inactive hydration product of TxA2) in the radial-artery and coronary-sinus blood of seven patients and performed therapeutic trials of antiplatelet agents in nine. Although coronary-sinus TxB2 levels rose from the base line approximately fivefold with spontaneous ischemia, samples drawn early in ischemia showed no rise over base-line values. Although a 150 mg dose of aspirin reduced urinary dinor-TxB2 levels by over 75 per cent, it had no effect on the course of the chronic recurrent form of angina pectoris due to vasospasm ("vasotonic angina"). Similarly, indomethacin had no effect on the frequency or duration of ischemia. TxA2 is unlikely to cause vasotonic angina, but it may be released during coronary vasospasm.

Topics: Adult; Angina Pectoris; Angina Pectoris, Variant; Arteries; Aspirin; Clinical Trials as Topic; Coronary Circulation; Coronary Vessels; Double-Blind Method; Female; Humans; Indomethacin; Ischemia; Male; Middle Aged; Recurrence; Thromboxane A2; Thromboxane B2; Thromboxanes; Time Factors; Veins

Topics: Angina Pectoris; Atherosclerosis; Blood Specimen Collection; Cardiovascular Agents; Coronary Angiography; Edetic Acid; Humans; Mean Platelet Volume; Metabolic Syndrome; Thromboxane A2

The current study was designed to investigate the number and affinity of platelet thromboxane A2/prostaglandin H2 (TxA2/PGH2) receptors in patients with unstable angina and, if any, the role played by the increased thrombin formation that is a common finding in these patients. Measurements taken during active unstable angina but not those taken during inactive angina showed an increase number (p < 0.001), without changes in affinity, of platelet TxA2/PGH2 receptors, evaluated as the binding capacity of iodine 125-PTA-OH, a stable TxA2 analogue. Moreover patients with active angina had higher plasma concentrations of fibrinopeptide A (FPA) (p < 0.0001), which were significantly related to the number of platelet TxA2/PGH2 receptors (r = 0.76; p < 0.01). Heparin infusion but not aspirin treatment promptly normalized the number of TxA2/PGH2 receptors and significantly reduced plasma FPA concentrations. In an in-vitro study thrombin in a concentration similar to that found in vivo significantly increased the number of platelet TxA2/PGH2 receptors (p < 0.01), whereas heparin did not affect TxA2/PGH2 receptors. These results have important therapeutic implications and indicate the preferential use of heparin rather than aspirin during the acute phase of unstable angina.

Topics: Aged; Angina Pectoris; Angina, Unstable; Aspirin; Blood Platelets; Dose-Response Relationship, Drug; Fibrinopeptide A; Heparin; Humans; Middle Aged; Physical Exertion; Platelet Activation; Prostaglandins H; Radioligand Assay; Receptors, Prostaglandin; Receptors, Thromboxane; Receptors, Thromboxane A2, Prostaglandin H2; Thrombin; Thromboxane A2

The thromboxane A2 receptor agonist, U-46619 ((5Z, 9 alpha, 11 alpha, 13E, 15(S))-9,11-(methanoepoxy)prosta-5,13-dien-1-oic acid) (10 micrograms/kg), induced a typical ischemic change (ST elevation) in the electrocardiogram on intracoronary arterial administration in the rat. The elevation of the ST segment induced by U-46619 was significantly reduced by pretreatment with anti-endothelin-1 rabbit serum. The plasma concentration of endothelin-1 dose dependently increased at the time of ST segment elevation after U-46619. These results indicate that endogenous endothelin-1 partly contributes to coronary spasmodic angina induced by thromboxane A2 in rats.

Topics: 15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5,13-dienoic Acid; Angina Pectoris; Animals; Electrocardiography; Endothelins; Injections, Intra-Arterial; Male; Myocardial Ischemia; Prostaglandin Endoperoxides, Synthetic; Radioimmunoassay; Rats; Rats, Sprague-Dawley; Thromboxane A2; Vasoconstrictor Agents

The authors examined the ratios of blood free polyunsaturated fatty acids (PUFA), such as 20:3n6, 20:4n6, 20:5n3, and 22:6n3, which are substrates and inhibitors of synthesis of thromboxane A2 and prostacyclins that regulate both normal blood fluidity, and platelet adhesion and primary thrombogenesis. The object of the study was plasma from healthy subjects and 4 groups of patients with cardiovascular diseases: 1) large myocardial infarction; 2) resting and exercise-induced angina pectoris; 3) large myocardial infarction; and 4) recurrent myocardial infarction. The levels of plasma free PUFA were measured by gas chromatography. Assessment of the PUFA ratios indicated that the risk for thrombogenesis increased in large and recurrent myocardial infarctions as compared to small myocardial infarction and angina pectoris both by reducing the relative levels of 20:3n6 and, in particular, 20:5n3, substrates of synthesis of only thrombolytics and vasodilators and by more greatly inhibiting the synthesis of prostacyclins than thromboxane with elevated 22:6n3 levels.

Topics: Aged; Aged, 80 and over; Angina Pectoris; Chromatography, Gas; Coronary Disease; Epoprostenol; Fatty Acids, Unsaturated; Female; Humans; Male; Middle Aged; Myocardial Infarction; Recurrence; Thromboxane A2

Thromboxane A2 (TxA2) is a pathogenic factor as it stimulates thrombogenesis and causes vasospastic reactions typical of coronary heart disease. The eicosapentaenic acid (EPA)-rich diet containing precursors of inactive TxA2 synthesis and the routine hospital diet (No. 10 according to Pevzner) were examined for effects on platelet generation of TxA2 on induction of ADP aggregation in 12 patients with first angina (FA). In patients with FA keeping diet No. 10, the platelets were found to be able to generate TxA2 under the influence of ADP, while in those on EPA-rich diet, the latter failed to exhibit this capacity. It was suggested that the EPA-containing fish diet might affect platelet aggregation favourably, which followed from the evidence for decreased pathogenic TxA2 generation in the aggregated platelets from FA patients and a lower risk of vascular spasms.

Topics: Adult; Angina Pectoris; Animals; Blood Platelets; Eicosapentaenoic Acid; Fishes; Humans; In Vitro Techniques; Male; Middle Aged; Platelet Aggregation; Thromboxane A2

STUDY OBJECTIVE - The objective was to measure platelet function in vivo (as cutaneous bleeding time), the role of catecholamines, and the effect of inhibiting thromboxane synthesis on bleeding time, in patients with myocardial infarction, unstable angina, and non-cardiac chest pain. DESIGN - Haemotological variables and plasma catecholamines were compared between patient diagnostic groups using the Kruskal-Wallis test, Conover's multiple comparison test, and Wilcoxon paired rank sum test. PATIENTS - 49 patients entered the study and 45 were assigned to three groups: myocardial infarction (n = 26), unstable angina (n = 9), and non-coronary chest pain (control) (n = 10). There were no significant differences between groups for age or sex. Patients with myocardial infarction smoked more than others. MEASUREMENTS and RESULTS - Compared to the controls, bleeding time in patients with myocardial infarction was shortened, while in unstable angina it was normal. Plasma adrenaline and noradrenaline concentrations were higher in the myocardial infarction group than in the unstable angina and control groups, but were not correlated with bleeding time. Bleeding time was remeasured 2 h after ingestion of 300 mg aspirin and increased in all subjects, especially in those with myocardial infarction, but it remained significantly shorter in the infarct group than in the comparison groups. Plasma adrenaline was inversely correlated with the bleeding time after aspirin in the infarct group. CONCLUSIONS - The shortened bleeding time may be an indicator of an increased prethrombotic tendency present in patients with myocardial infarction but not in those with unstable angina. The effect appears to be mediated by both thromboxane A2 and adrenaline.

Topics: Aged; Angina Pectoris; Angina, Unstable; Aspirin; Bleeding Time; Blood Platelets; Chest Pain; Epinephrine; Female; Humans; Male; Middle Aged; Myocardial Infarction; Norepinephrine; Thromboxane A2

Topics: Adult; Aged; Angina Pectoris; Anticoagulants; Cinnamates; Coronary Disease; Coumaric Acids; Female; Humans; Male; Middle Aged; Myocardial Infarction; Platelet Aggregation; Thromboxane A2

Thromboxane A2 (TxA2) generation and 1-14C arachidonic acid (AA) metabolism by platelets (stimulated with thrombin) were studied in vitro in 16 patients with unstable angina both during the acute and chronic inactive phase of the angina. Eight patients with stable effort angina and 21 controls were also investigated. In acute unstable angina 1-14C AA metabolism was significantly increased through cyclooxygenase pathway resulting in a higher selective TxA2 generation than in stable effort angina and in controls (p less than 0.01). No differences were found between patients with stable effort angina and controls. The alterations in AA metabolism were no longer found when patients reverted to the inactive phase of angina. TxA2 generation by platelets was independent of the number of the daily ischemic attacks (r = 0.17, ns) in patients with unstable angina. Present results indicate that an altered intraplatelet AA metabolism leading to the increased TxA2 synthesis occurs simultaneously with the conversion of angina from the chronic to the acute phase.

Topics: Acute Disease; Angina Pectoris; Angina, Unstable; Arachidonic Acid; Arachidonic Acids; Aspirin; Blood Platelets; Female; Humans; In Vitro Techniques; Male; Middle Aged; Thromboxane A2

In isolated perfused guinea pig hearts and in the cardiocirculatory system of anaesthetized rabbits the thromboxane A2-agonist U 46619 shows cardiodepressive effects. The contraction force of isolated auricle preparations from guinea pigs was enhanced. Antianginous drugs (dipyridamole, propranolol, verapamil, nitroglycerin and trapidil) induced a significant inhibition of the U 46619 effects. Oxyfedrine remained ineffective. The efficiency of some derivatives of trapidil was markedly diminished or abolished in comparison with the original substance. Because of the different chemical structure of the active drugs the TXA2-antagonism is regarded to be caused by a functional influence on the cellular membrane and the calcium transport. Nevertheless the inhibition of the TXA2-effects by antianginous drugs seems to be a factor for the therapeutic use of these substances.

Topics: Anesthesia; Angina Pectoris; Animals; Anti-Arrhythmia Agents; Blood Pressure; Cardiovascular Agents; Coronary Vessels; Dipyridamole; Guinea Pigs; In Vitro Techniques; Muscle Contraction; Muscle, Smooth, Vascular; Myocardial Contraction; Pyrimidines; Rabbits; Thromboxane A2; Trapidil

Topics: 15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5,13-dienoic Acid; Adenosine Diphosphate; Adult; Angina Pectoris; Coronary Disease; Humans; Middle Aged; Platelet Adhesiveness; Platelet Aggregation; Prostaglandin Endoperoxides, Synthetic; Thromboxane A2

To observe platelet TXA2 synthesizing activities in acute myocardial infarction (AMI, 38 cases) and effort angina (EA, 23 cases), radioimmunoassay was used to measure the amount of synthesized TXB2 at 5 min after an addition of arachidonic acid or thrombin to the platelet suspension. The amount of TXB2 in AMI patients did not show a significant difference from that of 13 healthy controls. However, there were significant changes during the time course of AMI. It increased in the super acute phase within the first 12 hrs from the onset of AMI. The activity decreased in 4 days, increased again in 10 days and then gradually recovered to the normal value. Platelet aggregation was elevated immediately after the onset of AMI and recovered during the time course. A significant negative correlation was observed between aggregation and TXA2 production in AMI, but not in the healthy controls, suggesting that platelets with hyper TXA2 synthesizing activity are consumed selectively in AMI. In EA, activity increased after treadmill exercise. Under ticlopidine-treatment, activity was depressed, and these patients were able to tolerate a longer exercise time than before ticlopidine. Since the pressure rate products did not change under treatment, changes in microcirculation such as the appearance of platelet aggregates may be important in the occurrence of anginal attacks.

Topics: Adolescent; Adult; Aged; Angina Pectoris; Blood Platelets; Coronary Disease; Female; Humans; Male; Middle Aged; Myocardial Infarction; Physical Exertion; Platelet Aggregation; Thromboxane A2; Ticlopidine; Time Factors

Lipid composition of platelet membranes and thromboxane A2 (TxA2) generation by platelets were investigated in eighty-seven anginal patients (forty-two with resting angina in active phase and forty-five with effort stable angina or rest angina in inactive phase) and in forty-five clinically healthy subjects of similar age. All subjects were on the same dietary regimen and the adherence to diet was checked by analysis of red blood cell lipids. Platelets from active angina patients produced more TxA2 than platelets from both inactive patients and controls (p less than 0.001). Moreover patients with active angina had higher arachidonic acid (AA, p less than 0.001) and lower eicosapentaenoic (EPA) and docosahexaenoic acid (DHA) levels in phosphatidylcholine (PC, p less than 0.001), than inactive patients and controls. AA and EPA changes in membrane PC significantly correlated with TxA2 production (p less than 0.001) but not with coronary pathoanatomy. Plasma lipids, content of cholesterol, total phospholipids (and their saturated and unsaturated fatty acids) and the different phospholipid fractions in platelet membrane were not different in the three groups. Present results indicate that in platelets from anginal patients phospholipid fatty acid composition is at least in part independent of plasma composition and that in active angina there are modifications leading to increased TxA2 formation and possibly contributing to the occurrence of ischemic attacks.

Topics: Adult; Angina Pectoris; Arachidonic Acid; Arachidonic Acids; Blood Platelets; Eicosapentaenoic Acid; Erythrocytes; Fatty Acids; Fatty Acids, Unsaturated; Female; Humans; Male; Membrane Lipids; Middle Aged; Phosphatidylcholines; Phospholipids; Prostaglandin-Endoperoxide Synthases; Thromboxane A2

Topics: Angina Pectoris; Angina, Unstable; Blood Platelets; Coronary Vessels; Endoscopy; Epoprostenol; Humans; Thromboxane A2

Pathological and clinical studies have suggested that platelets have a role in the pathogenesis of unstable angina and myocardial infarction. However, the relation of platelet activation to episodic ischemia in patients with unstable angina is unknown. We assessed the biosynthesis of thromboxane and prostacyclin as indexes of platelet activation in patients with stable and unstable coronary disease by physicochemical analysis of metabolites in plasma and urine. Prostacyclin biosynthesis was markedly elevated in patients with acute myocardial infarction and correlated with plasma creatine kinase (r = 0.795; P less than 0.001). The largest rise in thromboxane synthesis was observed in patients with unstable angina, in whom 84 percent of the episodes of chest pain were associated with phasic increases in the excretion of thromboxane and prostacyclin metabolites. However, 50 percent of such increases were not associated with chest pain, possibly reflecting silent myocardial ischemia. These data indicate that platelet activation occurs during spontaneous ischemia in patients with unstable angina. The increment in prostacyclin biosynthesis during such episodes may be a compensatory response of vascular endothelium that limits the degree or effects of platelet activation. If so, biochemically selective inhibition of the synthesis or action of thromboxane A2 would be desirable in the treatment of unstable angina. In contrast, thromboxane inhibitors or antagonists would not be expected to be effective in patients with chronic stable angina, in whom there was no increase in the formation of thromboxane A2.

Topics: 6-Ketoprostaglandin F1 alpha; Angina Pectoris; Angina, Unstable; Blood Platelets; Epoprostenol; Humans; Myocardial Infarction; Thromboxane A2; Thromboxane B2

We examined platelet aggregation and plasma levels of thromboxane B2, a stable metabolite of thromboxane A2, in patients with unstable angina and correlated these platelet indices with the response to antianginal conventional therapy such as isosorbide dinitrate and calcium channel blocker. Eight of 36 patients exhibited anginal attacks more than 5 times/week in spite of the therapy, designated refractory unstable angina, associated with augmented platelet aggregation induced by arachidonate (0.3 mM, 71 +/- 3%, mean +/- SEM) and collagen (2 micrograms/ml, 72 +/- 5%), and elevated plasma levels of thromboxane B2 (350 +/- 19 pg/ml). In the remainder of the patients whose anginal attacks were effectively subsided by the therapy, platelet aggregation was much lower (arachidonate: 34 +/- 9%, collagen: 31 +/- 8%, p less than 0.01) and plasma levels of thromboxane B2 were also lower (295 +/- 12 pg/ml, p less than 0.05). To evaluate the effect of selective thromboxane A2 blockade on clinical findings and platelet reactivity in refractory unstable angina, OKY-046 (600 mg/day, p.o.) was administered to another 14 patients with refractory unstable angina in addition to the conventional therapy. We found that platelet aggregation induced by arachidonate (71 +/- 4%) and collagen 65 +/- 8%) was markedly reduced (44 +/- 7% and 24 +/- 3%, respectively, p less than 0.01) and plasma levels of thromboxane B2 (358 +/- 31 pg/ml) and thromboxane B2 production in serum (29 +/- 5 ng/ml) were also significantly reduced after OKY-046 treatment (262 +/- 21 pg/ml, p less than 0.05, and 1.4 +/- 0.2 ng/ml, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Angina Pectoris; Angina, Unstable; Calcium Channel Blockers; Female; Humans; Isosorbide Dinitrate; Male; Methacrylates; Middle Aged; Platelet Aggregation; Thromboxane A2

Peripheral vascular resistance (PVR) and thromboxane A2(TxA2) synthesis after the cold pressor test were investigated in different subsets of patients with angina (10 with stable effort angina, 36 with resting angina [24 in an active phase and 12 in an inactive phase], and five with Prinzmetal's variant angina) and in 41 control subjects of equivalent age and risk factors. Left ventricular end-diastolic pressure, ejection fraction, extent of coronary angiographic lesions, and baseline PVR were not significantly different among the various patient groups. In all patient groups, except those with variant angina, the cold pressor test resulted in a higher increase in PVR than in the control subjects (p less than .001 for all groups). In patients with variant angina the vasoconstrictor response was increased only in proximity (about 1 hr) to ischemic attacks. In patients with active resting angina the vasoconstrictor response was on the average four times longer than that in patients with effort angina and with inactive resting angina (p less than .001). This exaggerated vasoconstrictor response was associated with elevated TxA2 resting levels in plasma and with increased TxA2 synthesis after the cold pressor test. A linear relationship was found between the area of the vascular response and the area of TxA2 production after the cold pressor test in patients with active resting angina (r = .87, p less than .001). The increased TxA2 synthesis and the inappropriate increase of peripheral vascular response to sympathetic stimulation revert back to normal in the inactive phase.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Angina Pectoris; Blood Pressure; Cold Temperature; Humans; Physical Exertion; Regional Blood Flow; Sympathetic Nervous System; Thromboxane A2; Thromboxane B2; Vascular Resistance

Spontaneous increase in platelet activity and change in coronary vasomotor tone have been implicated in the pathogenesis of acute myocardial ischemia. To define the mechanism of platelet "hypersensitivity" in acute myocardial ischemia, we examined the status of platelet alpha 2-adrenergic receptors in patients hospitalized with severe unstable angina. With the use of the specific alpha 2-receptor antagonist 3H-yohimbine, we identified a 26% decrease in the receptor binding sites on platelet membranes from patients with unstable angina compared with controls (155 +/- 32 vs. 210 +/- 29 fmol/mg protein, P less than or equal to 0.005). The dissociation constants of 3H-yohimbine binding to platelet alpha 2-receptors were similar in both groups (3.3 +/- 1.1 and 4.1 +/- 1.6 nmol/L, P not significant). To study the alterations in the affinity of platelet alpha 2-receptors for the agonists, effects of 1-epinephrine on specific binding of 3H-yohimbine were examined. We observed a marked reduction in 1-epinephrine concentration for inhibition of antagonist binding by 50% in acute myocardial ischemia (IC50: 4.2 +/- 3.9 X 10(-8) vs. 6.7 +/- 3.4 X 10(-7) mol/L, P less than or equal to 0.01), indicating increase in platelet alpha 2-receptor affinity for the agonist. Platelet aggregation and thromboxane A2 generation in response to epinephrine were also significantly increased in the acute phase of myocardial ischemia. This study suggests enhanced affinity of platelet alpha 2-receptors to the agonist 1-epinephrine as a possible mechanism of platelet hypersensitivity in acute myocardial ischemia.

Topics: Acute Disease; Adrenergic alpha-Agonists; Aged; Angina Pectoris; Angina, Unstable; Blood Platelets; Catecholamines; Coronary Disease; Epinephrine; Humans; Male; Middle Aged; Platelet Aggregation; Receptors, Adrenergic, alpha; Thromboxane A2; Thromboxane B2; Yohimbine

Despite numerous suggestions in the literature that thromboxane A2 is involved in a variety of occlusive vascular diseases, no definitive evidence is available. Arguments have been presented to support the view that such evidence can only come from clinical studies with a highly specific thromboxane receptor-blocking drug. We have now identified such a drug, AH23848, in our laboratories. Preliminary experiments with AH23848, ([1 alpha (Z), 2 beta,5 alpha]-(+/-)-7-[5-[[(1,1'-biphenyl)-4-yl]methoxy]-2-(4-morpholin yl)-3-oxocyclopentyl]-4-heptenoic acid), show that it is a potent, specific thromboxane receptor-blocking drug that is orally active and has a long duration of action. It should be a valuable tool in elucidating any physiologic or pathologic role of thromboxane A2.

Topics: Angina Pectoris; Animals; Biphenyl Compounds; Collagen; Dogs; Dose-Response Relationship, Drug; Guinea Pigs; Humans; In Vitro Techniques; Male; Muscle, Smooth, Vascular; Platelet Aggregation; Rats; Receptors, Cell Surface; Receptors, Prostaglandin; Receptors, Thromboxane; Shock, Septic; Thromboxane A2; Thromboxane-A Synthase; Vasoconstriction

To elucidate the contribution of prostanoids in coronary spasm, plasma levels of thromboxane B2 (TXB2) and 6-keto PGF1 alpha at the coronary sinus and ascending aorta in 21 patients with variant angina were measured, as compared with findings in 20 with effort angina and 13 subjects with normal coronaries. In the coronary sinus blood, plasma TXB2 in patients with effort angina exhibited statistically significant high levels, as compared with data in the controls. On the contrary, the data obtained from patients with variant angina were not statistically significant. However, eight patients whose coronary angiogram revealed more than 50% of coronary stenoses had statistically significant high levels of TXB2 and other patients with normal coronaries or less than 50% of narrowing showed almost the same levels of TXB2 as the controls. In contrast to TXB2, the plasma levels of 6-keto PGF1 alpha in patients with variant angina were very low in both groups with variant angina. These data suggest that high levels of TXB2 observed in patients with atherosclerotic coronaries may be an accelerating factor while low levels of prostacyclin may be an essential factor leading to spasm. HLA analysis of 23 patients with variant angina was performed to search for genetic factors, under the hypothesis that such may contribute to the low levels in prostacyclin. This preliminary study revealed statistically significant high frequencies of Bw52 and B-40 in the patients, as compared with frequencies among 152 normal Japanese. Genetic studies are ongoing in our clinic.

Topics: 6-Ketoprostaglandin F1 alpha; Aged; Angina Pectoris; Angina Pectoris, Variant; Coronary Vasospasm; Electrocardiography; Female; Histocompatibility Antigens Class II; HLA Antigens; Humans; Male; Middle Aged; Thromboxane A2; Thromboxane B2; Thromboxanes

Thromboxane B2 (TXB2), the stable metabolite of thromboxane A2 (TXA2), was measured in the coronary sinus and in aortic blood before and after cold pressor test (CPT) in 21 patients suffering from ischemic heart disease (7 affected by stable effort angina and 14 by unstable angina) and in 12 patients not suffering from myocardial ischemia (control group) during coronary angiography. Aspirin (10 mg/kg intravenously) was administered before catheterization in order to prevent platelet and leukocyte TXA2 formation. Control subjects and patients with effort angina had TXB2 resting levels lower than unstable angina patients without a transcardiac gradient which, on the contrary, was found in unstable angina patients. Only in these patients CPT resulted in a significant TXB2 increase more marked in the coronary sinus (from 50.0 +/- 18.9 pg/ml to 73.0 +/- 35.1 pg/ml, p less than 0.001) than in the aorta (from 33.4 +/- 17.1 pg/ml to 42.6 +/- 24.0 pg/ml, p less than 0.05), so that the transcardiac TXB2 gradient significantly increased. In all but two unstable angina patients, TXB2 elevation was not associated with a fall of cardiac lactate extraction. The resting and CPT-induced TXB2 gradients were unrelated to the presence and severity of coronary angiographic lesions. These results indicate that unstable angina patients show an abnormal cardiocoronary capacity to synthesize TXA2, which seems not to be elicited by the occurrence of myocardial ischemia.

Topics: Adult; Aged; Angina Pectoris; Angina, Unstable; Aorta; Cold Temperature; Coronary Angiography; Coronary Vessels; Female; Humans; Lactates; Male; Middle Aged; Sympathetic Nervous System; Thromboxane A2; Thromboxane B2; Thromboxanes

Patients with polycythemia vera have been described to have hemorrhagic as well as thrombotic tendencies. In a patient with polycythemia vera and angina pectoris, we observed markedly decreased platelet aggregation response to epinephrine but increased platelet and whole-blood thromboxane A2 generation compared with normal subjects. Electron microscopy mostly showed partially activated forms of platelets, which may account for decreased aggregation response in vitro and hemorrhagic tendencies. Young and large platelets found in this disease, however, can generate large amounts of vasoconstrictor and platelet proaggregatory prostanoid thromboxane A2 in response to endogenous thrombin, which may be a basis for thrombotic tendencies.

Topics: Angina Pectoris; Blood Platelets; Humans; Male; Microscopy, Electron; Middle Aged; Platelet Aggregation; Polycythemia Vera; Thromboxane A2; Thromboxane B2; Thromboxanes

Topics: Adult; Aged; Angina Pectoris; Angina Pectoris, Variant; Angina, Unstable; Aorta; Aspirin; Blood Pressure; Coronary Circulation; Coronary Disease; Coronary Vessels; Epoprostenol; Female; Hemodynamics; Humans; Male; Middle Aged; Myocardial Infarction; Platelet Aggregation; Prostaglandins; Thromboxane A2; Thromboxane B2

Topics: Angina Pectoris; Animals; Blood Platelets; Coronary Vessels; Epoprostenol; Humans; Isosorbide Dinitrate; Nitroglycerin; Platelet Aggregation; Stimulation, Chemical; Thromboxane A2

Under physiologic conditions the tone of the epicardial coronary arteries plays a minimal role in the regulation and distribution of myocardial blood flow. However, under pathophysiologic conditions, especially in coronary heart disease, even small changes in tone may play an eminent role. A uniform mechanism for the induction of excessive coronary constriction and spasm is as yet not recognizable. It is probably a multifactorial event in which different, variable factors add to or potentiate each other. This constriction or spasm inducing chain can with certainty only be interrupted at one of its last links: prevention of an excessive activation of the smooth vascular contractile apparatus through a reduction of the activating calcium influx (calcium antagonists) or through an increase of the intracellular cGMP-content with nitrates (through a not yet identified relaxation procedure). In this brief review constriction-inducing or -potentiating factors are discussed in context with the "dynamic stenosis:" alpha-adrenergic and parasympathetic mechanisms, serotonin, histamine, prostanoids and leukotrienes, finally changes of endothelial factors. Under experimental conditions these factors may bring about a more or less pronounced coronary constriction. In animal experiments it is only possible in mini-pigs with experimental coronary atheromatosis or sclerosis (in combination with experimental endothelial damage) to induce spasm-like constrictions of the large epicardial arteries using histamine or serotonin. Under a variety of clinical conditions the importance of these factors for the induction of dynamic coronary stenoses was shown to be of potential significance.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Angina Pectoris; Animals; Coronary Circulation; Coronary Disease; Coronary Vessels; Endothelium; Histamine; Humans; Muscle Tonus; Muscle, Smooth, Vascular; Myocardium; Oxygen Consumption; Receptors, Adrenergic; Receptors, Serotonin; Serotonin; Thromboxane A2; Vascular Resistance; Vasoconstriction

To determine thromboxane A2 release in coronary artery disease, we measured its stable metabolite thromboxane B2 by radioimmunoassay in 20 patients. In 15 patients with stable disease (last angina episode greater than 96 hours before study), coronary venous thromboxane B2 concentrations were lower than in aortic blood (mean 109 +/- 36 vs 194 +/- 40 pg/ml, p less than 0.001). In contrast, in five other patients with spontaneous angina, coronary venous thromboxane B2 concentrations were higher than aortic thromboxane B2 concentrations during the angina episode (mean 1716 +/- 316 vs 875 +/- 388 pg/ml, p less than 0.02). Plasma thromboxane B2 levels were in the normal range (mean 175 +/- 35 pg/ml) in patients with stable angina but significantly (p less than 0.02) higher in patients with spontaneous angina. With atrial pacing to the point of chest pain and/or ECG changes in patients with stable coronary artery disease, aortic thromboxane B2 concentrations increased in 10 of 13 patients (mean 283 +/- 70 pg/ml, p less than 0.02). Coronary venous thromboxane B2 concentrations increased in seven patients at peak pacing rates (mean 223 +/- 76 pg/ml) and in three other patients after termination of pacing. These data indicate that release of thromboxane A2 is much greater during spontaneous angina than with pacing stress in patients with coronary artery disease. Thromboxane A2 released during spontaneous or pacing-induced angina may modulate coronary and systemic vascular tone. Enhanced thromboxane A2 activity may either precede or follow myocardial ischemia and could be a factor in the initiation and propagation of the ischemic episode.

Topics: Adult; Aged; Angina Pectoris; Aorta; Cardiac Catheterization; Cardiac Pacing, Artificial; Coronary Disease; Coronary Vessels; Humans; Male; Middle Aged; Prostaglandins; Thromboxane A2; Thromboxane B2; Thromboxanes

Topics: Angina Pectoris; Angina, Unstable; Epoprostenol; Humans; Male; Middle Aged; Prognosis; Thromboxane A2

Topics: 6-Ketoprostaglandin F1 alpha; Adult; Aged; Angina Pectoris; Epoprostenol; Humans; Middle Aged; Myocardial Infarction; Radioimmunoassay; Thromboxane A2; Thromboxane B2; Thromboxanes

Topics: Angina Pectoris; Cardiac Pacing, Artificial; Cardiovascular Diseases; Cardiovascular Physiological Phenomena; Coronary Disease; Hemodynamics; Humans; Myocardial Infarction; Prostaglandins; Risk; Thromboxane A2; Thromboxane B2

Platelet count, and plasma thromboxane B2 (TXB2) and circulating platelet aggregates (CPA) were determined in the coronary sinus (CS), aortic bulb (AO) and cubital vein (V) in 21 patients with stable angina and in 6 control subjects before and after atrial pacing (AP). TXB2 measurements were repeated before and after AP in 6 of the 21 angina patients after 15 days' sulphinpyrazone treatment. Platelet count and CPA ratio were similar in angina patients and controls at all three sampling sites and were unchanged at AP peak. In the controls, basal TXB2 values in CS, AO and V were not significantly different and were unchanged at AP peak. In the angina patients compared with the controls, basal TXB2 values in the AO, CS and V were not significantly different whereas the CS/AO TBX2 ratio was significantly higher; at AP-induced ischaemia, CS TXB2 was significantly increased and the CS/AO TXB2 ratio was increased. A weak but significant direct correlation was found between CS/AO TXB2 ratio and coronary score. Sulphinpyrazone treatment reduced CS TXB2 levels at rest and after AP, but not the ischaemic threshold at AP.

Topics: Adult; Aged; Angina Pectoris; Blood Platelets; Female; Humans; Male; Middle Aged; Platelet Aggregation; Platelet Count; Sulfinpyrazone; Thromboxane A2; Thromboxane B2; Thromboxanes

The effect of atrial pacing on intracoronary thromboxane production was investigated in 35 patients with stable (n = 19) or unstable (n = 16) angina. Arterial and coronary sinus thromboxane B2, the stable metabolite of thromboxane A2, myocardial lactate extraction and thermodilution coronary sinus flow were measured before, during and immediately after atrial pacing until the onset of angina. Pacing did not significantly increase coronary sinus thromboxane B2 (rest, 233 +/- 107 pg/ml; pacing, 249 +/- 154 pg/ml; postpacing, 330 +/- 309 pg/ml) (mean +/- standard deviation) despite a moderate increase in arterial thromboxane B2 (rest, 270 +/- 170 pg/ml; pacing, 387 +/- 364 pg/ml; postpacing, 446 +/- 420 pg/ml) (all changes probability [p] less than 0.05). A positive transmyocardial thromboxane B2 gradient, suggesting intracoronary thromboxane A2 production, occurred in only five patients at rest (gradient = 60 +/- 35 pg/ml). During pacing, a transmyocardial thromboxane B2 gradient was not observed despite myocardial lactate production in 18 patients. A postpacing gradient was observed in eight patients (gradient = 284 +/- 349 pg/ml). These gradients were significantly more frequent in patients who produced lactate during pacing (7 of 18) than in patients without lactate production (1 of 17) (p less than 0.05). In patients with and without a postpacing gradient, coronary vascular resistance decreased with pacing and returned to rest levels immediately after pacing, suggesting that a postpacing thromboxane gradient does not significantly alter coronary tone. These data suggest that: 1) pacing-induced angina is usually not associated with substantial intracoronary thromboxane A2 production; 2) in a minority of patients who develop intracoronary thromboxane A2 production, the amount is small and does not produce significant coronary vasoconstriction.

Topics: Angina Pectoris; Cardiac Catheterization; Cardiac Pacing, Artificial; Coronary Disease; Female; Hemodynamics; Humans; Lactates; Lactic Acid; Male; Middle Aged; Thromboxane A2; Thromboxane B2; Thromboxanes

The influence of molsidomin (4 mg i.v.) on platelet function, on the plasma concentrations of 6-oxo-PGF1 alpha, the stable metabolite of prostaglandin I2, and thromboxane B2, the stable metabolite of thromboxine A2 was determined in ten patients with coronary heart disease. Prostaglandin I2 is generated in the vessel wall and is a potent vasodilator and inhibitor of platelet aggregation, whereas thromboxane A2 is a vasoconstrictor and a proaggregatory substance. In addition, in-vitro tests were performed, too. 60 min after bolus injection a decrease of systolic and diastolic blood pressure was observed, whereas heart rate remained nearly constant. Platelet aggregation decreased significantly; the addition of PGI2 in vitro had an additive effect. The plasma concentrations of 6-oxo-PGF1 alpha increased after 60 minutes, whereas thromboxane B2 concentrations remained unchanged. In vitro, SIN1, a metabolite of molsidomin generated in the liver, led to a dose-dependent inhibition of ADP-induced platelet aggregation, whereas molsidomin was nearly inactive. Thus molsidomin shows an inhibition of platelet function besides the known antianginal properties. The vasodilatatory and platelet inhibiting effects of this compound may be due partly to a stimulation of the prostaglandin I2 synthesis in the vessel wall.

Topics: Angina Pectoris; Blood Pressure; Coronary Disease; Epoprostenol; Female; Humans; Male; Molsidomine; Muscle, Smooth, Vascular; Oxadiazoles; Platelet Aggregation; Prostaglandins F; Sydnones; Thromboxane A2; Thromboxane B2

Topics: Angina Pectoris; Angina Pectoris, Variant; Animals; Aspirin; Blood Platelets; Coronary Circulation; Dogs; Epoprostenol; Humans; Indomethacin; Platelet Aggregation; Thromboxane A2; Thromboxane B2; Thromboxanes

To examine plasma levels of vasoconstrictive prostanoid (thromboxane A2) in patients with coronary artery disease, amounts of its product, thromboxane B2, in acidic lipid extracts from plasma were determined by a radioimmunoassay. Peripheral venous samples were obtained in 14 normal subjects and 12 patients with coronary artery disease, and simultaneous aortic and coronary sinus blood samples were obtained at rest, during pacing, and after pacing in eight cases who were subjected to atrial pacing stress test. Mean thromboxane B2 levels in peripheral venous blood in 14 normal subjects were found to be 243 +/- 96 pg/ml. Of nine cases with angina pectoris on effort (angiographically documented severe coronary artery stenosis), five exhibited increased thromboxane B2 levels in peripheral plasma. Three cases of a variant form of angina pectoris exhibited pronounced increases in peripheral thromboxane B2 levels. Of eight cases subjected to atrial pacing stress test, three exhibited marked increases in thromboxane B2 levels in coronary sinus effluent at peak pacing, two of which were accompanied by typical anginal pain during the test. These findings suggest that increased thromboxane A2 production may be associated with altered thromboxane metabolism. This may occur because of altered interactions between functions of vascular wall and blood platelets within coronary circulation in patients with coronary artery disease.

Topics: Angina Pectoris; Angina Pectoris, Variant; Cardiac Pacing, Artificial; Coronary Disease; Humans; Male; Radioimmunoassay; Thromboxane A2; Thromboxane B2; Thromboxanes