Sequential Treatment of Deep Leg Vein Thrombosis with Porcine Plasmin and Low Dose Streptokinase

Summary

Sequential treatment of deep leg vein thrombosis with porcine plasmin and low dose streptokinase (10,000-20,000 U/h) produces strong systemic fibrinolysis as demonstrated by the sustained decrease of euglobulin lysis time, of thromboplastin time values in percent, fibrinogen and factor V levels. There is a statistically significant negative correlation between thrombolytic results and euglobulin lysis time. Treatment periods below 3 days are unlikely to give satisfactory results. Occluded vein segments with an apparent median age of 4 days including thrombi older than 10 days (20% of cases) are cleared with an average chance of 50%. Complete dissolution of all thrombi proximal to the crural veins has been demonstrated in 47/114 = 41.2%, some thrombolytic effect in 31/114 = 27.2% and treatment failure in 36/114 = 31.6%. The data favour laboratory monitoring of thrombolytic therapy.

Keywords

Deep vein thrombosis - Streptokinase - Porcine plasmin - Vein segment thrombolysis score - Treatment duration - Clotting parameters - Euglobulin lysis time

• References

• 1 Bell WR, Meek AG. Guidelines for the use of thrombolytic agents. N Engl J Med 1979; 301: 1266-1270
• 2 Marder VJ. The use of thrombolytic agents: Choice of patient, drug administration, laboratory monitoring. Ann Int Med 1979; 90: 802-808
• 3 Arnesen H, Heilo A, Jakobsen E, Ly B, Skaga E. A prospective study of streptokinase and heparin treatment of deep vein thrombosis. Acta Med Scand 1978; 203: 457-463
• 4 Duckert F, Müller G, Nyman D, Benz A, Prisender S, Madar G, da Silva MA, Widmer LK, Schmitt HE. Treatment of deep vein thrombosis with streptokinase. Br Med J 1975; 1: 479-481
• 5 Marbet GA, Walter M, Six P, Nyman D, Rüst O, Biland L, Duckert F, Madar G, da Silva A, Widmer LK, Schmitt HE, Vokal J. Vergleich verschiedener fibrinolytischer Methoden zur Behandlung venöser Thrombosen. In Neuhaus K, Duckert F. (eds) Blutgerinnung und Antikoagulation. Schattauer, Stuttgart: 1976: 87-99
• 6 Marbet GA, Duckert F, Ritz R, Widmer LK, da Silva MA, Biland L, Schmitt HE. Side effects of thrombolytic treatment with porcine plasmin and low dose streptokinase. Thromb Haemostas 1982; 48: 196-200
• 7 Clauss A. Gerinnungsphysiologische Schnellmethode zur Bestimmung des Fibrinogens. Acta haematol (Basel) 1957; 17: 237-246
• 8 Fischbacher W. Beitrag zur fibrinolytischen Therapie mit Streptokinase und Fibrinolysin. Thrombos Diathes Haemorrh 1961; 6: 547-572
• 9 Kappeler R. Das Verhalten von Faktor V im Serum unter normalen und pathologischen Bedingungen. Z klin Med 1955; 153: 103-113
• 10 Milstone H. A factor in normal human blood which participates in streptococcal fibrinolysis. J Immunol 1941; 42: 109-116
• 11 Lämmle B, Eichlisberger R, Marbet GA, Duckert F. Amidolytic activity in normal human plasma assessed with chromogenic substrates. Thromb Res 1979; 16: 245-254
• 12 Friberger P, Knös M, Gustavsson S, Aurell L, Claeson G. Methods for determination of plasmin, antiplasmin and plasminogen by means of substrate S-2251. Haemostasis 1978; 7: 138-145
• 13 Kabi Diagnostica. S-2251. Determination of plasminogen in plasma. Laboratory instruction
• 14 Teger-Nilsson AC, Friberger P, Gyzander E. Determination of a rapid plasmin inhibitor in human blood by means of a specific tripeptide substrate. Scand J Clin Lab Invest 1977; 37: 403-409
• 15 Laurell CB. Quantitative estimation of proteins by electrophoresis in agarose gels containing antibodies. Anal Biochem 1966; 15: 45-52
• 16 Schmitt HE. Aszendierende Phlebographie bei tiefer Venenthrombose. Aktuel Probi Angiologie. Huber-Verlag, Bern 1977; 36: 1-170
• 17 Armitage P. Statistical methods in medical research. Blackwell Scientific Publications; Oxford: 1977
• 18 Hedner U, Johansson L, Nilsson IM. Effect of porcine plasmin on the coagulation and fibrinolytic systems in humans. Blood 1978; 51: 157-164
• 19 Chesterman CN, Allington MJ, Sharp AA. Relationship of plasminogen activator to fibrin. Nature 1972; 238: 15-17
• 20 Wiman B, Collen D. Molecular mechanism of physiological fibrinolysis. Nature 1978; 272: 549-550
• 21 Collen D. On the regulation and control of fibrinolysis. Thromb Haemostas 1980; 43: 77-89
• 22 Conard J, Samama M. Laboratory control of SK therapy. In Losito R. (ed.) Present status of thrombosis. Its pathophysiology, diagnosis and treatment Schattauer, Stuttgart: 1973: 191-198
• 23 Duckert F, Benz A, Prisender S, da Silva A, Schmitt HE. Coagulation parameters and success of thrombolytic treatment in deep vein thrombosis. Vasa 1974; 3: 138-139