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Thromb Haemost 1977; 37(01): 162-169
DOI: 10.1055/s-0038-1649214
Original Article
Schattauer GmbH

Intermittent Plasminogen-Streptokinase Treatment of Deep Vein Thrombosis

M. F Scully
1   Thrombosis Research Unit, King’s College Hospital Medical School, Denmark Hill, London SE5 8RX, England
,
D. A Lane
1   Thrombosis Research Unit, King’s College Hospital Medical School, Denmark Hill, London SE5 8RX, England
,
S Sagar
1   Thrombosis Research Unit, King’s College Hospital Medical School, Denmark Hill, London SE5 8RX, England
,
D. P Thomas
1   Thrombosis Research Unit, King’s College Hospital Medical School, Denmark Hill, London SE5 8RX, England
,
V. V Kakkar
1   Thrombosis Research Unit, King’s College Hospital Medical School, Denmark Hill, London SE5 8RX, England
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Publikationsverlauf

Received 04. August 1976

Accepted 20. Oktober 1976

Publikationsdatum:
03. Juli 2018 (online)

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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
    CrossrefPubMedGoogle Scholar
  • 2 Alkjaersig N, Fletcher A.P, Sherry S. The mechanism of clot dissolution by plasmin. Journal of Clinical Investigation 1959; 38: 1086
    CrossrefPubMedGoogle Scholar
  • 3 Ambrus C.M, Markus G. Plasmin-antiplasmin complex as a reservoir of fibrinolytic enzyme. American Journal of Physiology 1960; 199: 496
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 5 Blomräck B, Blombäck M. Purification of human and bovine fibrinogen. Arkiv für Chemi 1956; 10: 415
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 7 Cash J.D. Monitoring fibrinolysis. Postgraduate Medical Journal (August Supplement) 1973; 37
    PubMedGoogle Scholar
  • 8 Chesterman C.N, Allington M.J, Sharp A.A. Relationship of plasminogen activator to fibrin. Nature New Biology 1972; 238: 15
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 11 Hardisty R.M, Ingram G.I.C. Bleeding Disorders. Blackwell Scientific Publications; Oxford: 1965
    Google Scholar
  • 12 Kakkar V.V, Sagar S, Lewis M. Treatment of deep vein thrombosis with intermittent streptokinase and plasminogen infusion. Lancet 1975; 2: 674
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 14 Robbins K.C, Summaria L. Human plasminogen and plasmin. Methods in Enzymology 1970; 19: 184
    PubMedGoogle Scholar
  • 15 Sagar S, Rice L, Kakkar V.V. Unpublished observations. 1975
    PubMed
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 20 Verstraete M, Vermylen J, Amery A, Vermylen C. Thrombolytic therapy with streptokinase using a standard dosage scheme. British Medical Journal 1966; 1: 454
    CrossrefPubMedGoogle Scholar
  • 21 Verstraete M. The present status of thrombolytic agents. Drugs 1973; 5: 353
    CrossrefPubMedGoogle Scholar