To the Editor:—
In The Journal, June 27, page 101, Dr. Paul W. Boyles reported a severe systemic reaction to intravenous fibrinolysin therapy, with high fever, hypertension, angioneurotic edema, and mental confusion. While patients I have treated with the preparation that he used have shown some febrile reactions and while it is hoped that a more purified product will reach the market, attention should be called to two factors that may have contributed to the severity of the reaction. First, 200,000 units is twice the recommended dose; in fact, 50,000 units as a starting dose is probably safer. Second, the injection is customarily given slowly over a period of two to five hours and dissolved in 500 cc. of 5% dextrose solution and not given in 15 minutes as in the reported case. We have given concentrated solutions intra-arterially only, hoping they would act regionally on the soft fresh clot.