Selective Inhibition of Factor X Is More Efficient Than Factor VIIa–Tissue Factor Complex Blockade at Facilitating Coronary Thrombolysis in the Canine Model

Objectives. We determined the effect of adjunctive inhibition of the extrinsic coagulation pathway by factor VIIa–tissue factor complex inhibitors, DEGR VII and tissue factor pathway inhibitor (TFPI), and the selective factor X inhibitor, tick anticoagulant peptide (TAP), after thrombolytic therapy with tissue-type plasminogen activator (t-PA) in canine model of electrically induced coronary thrombosis. Background. Ongoing thrombin generation is considered an important component of the heightened thrombin activity associated with thrombolytic therapy and may be responsible for reperfusion failure and reocclusion. Methods. Forty-two dogs with electrically induced coronary thrombus undergoing thrombolysis with t-P (1 mg/kg over 20 min) were randomly assigned to one of the following adjunctive regimens: TAP (30 μg/kg body weight per min for 90 min, n = 10); TFPI (100 to 150 μg/kg per min for 90 min, n = 10); DEGR VII (1- to 2-mg/kg bolus, n = 10) and saline control (n = 12). The dogs were observed for 120 min after thrombolysis for reocclusion. Results. All three active study agents accelerated the time to reperfusion by an average of 12 min (all p < 0.05). Duration of reflow was greatest with TAP (117 ± 8 min, p < 0.05 compared with saline control), whereas DEGR VII and TFPI did not prolong the duration of reflow. Reocclusion rates were similar among control, DEGR VII and TFPI groups (70%, 78% and 67%, respectively). Tick anticoagulant peptide reduced the occurrence of reocclusion (0%, p < 0.05 compared with saline control). Conclusions. In this experimental model, during systematic blockade of various extrinsic coagulation pathway proteins, we demonstrated that whereas acceleration of thrombolysis occurs with factor VIIa–tissue factor complex inhibition, optimal enhancement of thrombolysis was achieved through specific factor X blockade.