Platelet activation in unstable coronary disease

N Engl J Med. 1986 Oct 16;315(16):983-9. doi: 10.1056/NEJM198610163151602.


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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • 6-Ketoprostaglandin F1 alpha / analogs & derivatives
  • 6-Ketoprostaglandin F1 alpha / urine
  • Angina Pectoris / blood*
  • Angina, Unstable / blood*
  • Blood Platelets / physiology*
  • Epoprostenol / biosynthesis*
  • Humans
  • Myocardial Infarction / blood
  • Thromboxane A2 / biosynthesis*
  • Thromboxane B2 / analogs & derivatives
  • Thromboxane B2 / urine


  • Thromboxane B2
  • Thromboxane A2
  • 6-Ketoprostaglandin F1 alpha
  • 2,3-dinor-thromboxane B2
  • 2,3-dinor-6-ketoprostaglandin F1alpha
  • 11-dehydro-thromboxane B2
  • Epoprostenol