Subscribe to RSS
DOI: 10.1055/s-0038-1649214
Intermittent Plasminogen-Streptokinase Treatment of Deep Vein Thrombosis
Publication History
Received 04 August 1976
Accepted 20 October 1976
Publication Date:
03 July 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00035024/197701/lookinside/thumbnails/10-1055-s-0038-1649214-1.jpg)
Summary
The fibrinolytic response of 12 patients receiving single daily infusions of 600,000 units of streptokinase (SK) and 90 mg of plasminogen for the treatment of DVT has been studied. The mean plasminogen concentration was maintained throughout the treatment period (4–6 days) at between 20–40 % the initial value, while mean circulating plasmin concentration rose to only about twice initial plasma levels. The degradation of fibrinogen as indicated by a fall in clottable fibrinogen and rise in serum FDP varied appreciably from patient to patient. In 9 patients fibrinogen did not fall below 1 mg/ml and serum FDP rose to greater than 1 mg/ml. Limited fibrinogenolysis occurred in 2 patients, while in another patient who bled there was immediate and extensive depletion to below 0.5 mg/ml. The beneficial clinical results obtained with this regimen (Kakkar et al. 1975), which produces only limited systemic plasminaemia, suggest that thrombolysis may be facilitated by higher levels of plasminogen than those maintained during conventional SK treatment.
-
References
- 1 Abiko Y, Iwamoto M, Shimizu M. Plasminogen-plasmin system. I. Purification and properties of human plasminogen. The Journal of Biochemistry 1968; 64: 743
- 2 Alkjaersig N, Fletcher A.P, Sherry S. The mechanism of clot dissolution by plasmin. Journal of Clinical Investigation 1959; 38: 1086
- 3 Ambrus C.M, Markus G. Plasmin-antiplasmin complex as a reservoir of fibrinolytic enzyme. American Journal of Physiology 1960; 199: 496
- 4 Amery A, Donati M.B, Vermylen J, Verstraete M. Comparison between the changes in the fibrinogen and plasminogen levels induced by a moderate or high initial dose of streptokinase. Thrombosis et Diathesis Haemorrhagica 1970; 23: 504
- 5 Blomräck B, Blombäck M. Purification of human and bovine fibrinogen. Arkiv für Chemi 1956; 10: 415
- 6 Brogden R.N, Speight T.M, Avery G.S. Streptokinase: A review of its pharmacology, mechanism of action and therapeutic uses. Drugs 1973; 5: 357
- 7 Cash J.D. Monitoring fibrinolysis. Postgraduate Medical Journal (August Supplement) 1973; 37
- 8 Chesterman C.N, Allington M.J, Sharp A.A. Relationship of plasminogen activator to fibrin. Nature New Biology 1972; 238: 15
- 9 Duckert F, Muller G, Nyman D, Benz A, Prisender S, Madar G, Da Silva M.A, Widmer L.K, Schmitt H.E. Treatment of deep vein thrombosis with streptokinase. British Medical Journal 1975; 1: 479
- 10 Fletcher A.P, Alkjaersig N, Sherry S. The maintenance of a sustained thrombolytic state in man. I. Induction and effect. Journal of Clinical Investigation 1959; 38: 1096
- 11 Hardisty R.M, Ingram G.I.C. Bleeding Disorders. Blackwell Scientific Publications; Oxford: 1965
- 12 Kakkar V.V, Sagar S, Lewis M. Treatment of deep vein thrombosis with intermittent streptokinase and plasminogen infusion. Lancet 1975; 2: 674
- 13 Robbins K.C, Summaria L, Hsieh B, Shah R.J. The peptide chains of human plasmin: Mechanism of activation of human plasminogen to plasmin. Journal of Biological Chemistry 1967; 242: 2333
- 14 Robbins K.C, Summaria L. Human plasminogen and plasmin. Methods in Enzymology 1970; 19: 184
- 15 Sagar S, Rice L, Kakkar V.V. Unpublished observations. 1975
- 16 Scully M.F, Strachan C.J.L, Kakkar V.V. Binding of iodinated proteins to forming and preformed thrombi. Biochemical Society Transactions 1973; 1: 1204
- 17 Strachan C.J.L, Scully M.F, Kakkar V.V. The behaviour of isotope labelled blood proteins in thrombosis. Thrombosis Research 1974; 4: 303
- 18 Thorsen S. Differences in the binding to fibrin of native plasminogen and plasminogen modified by proteolytic degradation. Influence of w-aminocarboxylic acids. Biochimica et Biophysica Acta 1975; 393: 55
- 19 Tytgat G.N, Collen D, Vermylen J. Metabolism and distribution of fibrinogen. II Fibrinogen turnover in polycythaemia, thrombocytosis, haemophilia, congenital afibrinogenaemia and during streptokinase therapy. British Journal of Haematology 1972; 22: 701
- 20 Verstraete M, Vermylen J, Amery A, Vermylen C. Thrombolytic therapy with streptokinase using a standard dosage scheme. British Medical Journal 1966; 1: 454
- 21 Verstraete M. The present status of thrombolytic agents. Drugs 1973; 5: 353