Intracoronary Magnesium and Diltiazem Affect to a Similar Extent Certain Hemostatic Factors during Acute Myocardial Infarction in Swine

Abstract

The use of calcium antagonists and magnesium (Mg) in the treatment of acute myocardial infarction is controversial. We compared changes in hemostasis during acute myocardial infarction after either low-dose intracoronary Mg or diltiazem infusion in 20 Yorkshire swine undergoing thoracotomy and coronary artery occlusion for 50 min, followed by 3 h of reperfusion. The first group received MgSO₄ (250 mg), delivered at the onset of reperfusion, the second group received diltiazem (2.5 mg) at the beginning of reperfusion. Six controls received saline. Plasma antithrombin III, protein C, total protein S, fibronectin, endothelin 1, and metabolites of thromboxane and prostacyclin were measured at baseline, twice during occlusion, and three times during reperfusion. Compared to controls, Mg and diltiazem infusion diminished endothelin 1 (32.9 vs. 34.5%) and fibronectin (21.7 vs. 23.2%), but increased protein C (31.9 vs. 29.3%). Intracoronary Mg, like diltiazem, improved hemostasis in swine.

Effects of magnesium sulphate on coagulation after laparoscopic colorectal cancer surgery, measured by rotational thromboelastometry (ROTEM®)

“…In contrast to the many studies of magnesium on platelet function, its effects on coagulation and fibrinolysis are less well documented and inconclusive. Some investigators reported that magnesium improved haemostasis or attenuated haemodilution‐induced or postoperative hypercoagulability . However, other studies have shown no difference in coagulation markers or fibrinolytic activity .…”

Effects of magnesium sulphate on postoperative coagulation, measured by rotational thromboelastometry (ROTEM®)*

“…Calcium acts as a cofactor throughout the coagulation cascade. Experimental animal studies have confirmed that magnesium infusion leads to an increase in protein C levels, an inhibitor of activated factors V and VIII [28, 29]. These coagulation factors are involved in the intrinsic pathway, and certainly magnesium seemed to exert a greater influence on the intrinsic pathway (i.e.…”