0
ARTICLE |

TREATMENT OF THROMBOSIS WITH FIBRINOLYSIN (PLASMIN) FREE

Joseph E. Sokal, M.D.; Julian L. Ambrus, M.D., Ph.D.; Clara M. Ambrus, M.D., Ph.D.
[+] Author Affiliations

Buffalo

From the Roswell Park Memorial Institute and the University of Buffalo Medical School.


JAMA. 1958;168(10):1314-1323. doi:10.1001/jama.1958.03000100016004
Text Size: A A A
Published online

The possibility of dissolving a recent thrombus by the intravenous administration of a fibrinolytic enzyme was studied in a series of patients. Fibrinolysin (plasmin) was prepared in several ways from human and bovine plasma, and preparations were obtained from other laboratories also. Altogether 114 infusions of fibrinolysin were given to 37 volunteer patients, most of whom had incurable cancer. Thirteen episodes of acute thrombophlebitis, occurring in 10 patients of this series, were treated. In five of the eight cases in which the age of the thrombus was three days or less, complete resolution was obtained. When improvement did occur, the pattern of response was fairly uniform; pain was relieved within 24 hours, color improved and tenderness disappeared shortly thereafter, and edema disappeared within a few days. The results, which were sometimes striking, are illustrated in 14 case histories. Fibrinolysin was ineffective when given a week or more after the first manifestations of thrombosis, and it did not prevent the formation of fresh thrombi. The mechanism of its action upon blood clots in vitro as well as the clinical experiences here reported argue in favor of simultaneous administration of anticoagulants with fibrinolysin in the management of acute thromboses.

REFERENCES

Innerfield, I.:  Trypsin Given Intramuscularly in Chronic, Recurrent Thrombophlebitis , J. A. M. A. 156:1056-1058 ( (Nov. 13) ) 1954;.
Taylor, A.; Overman, R. S.; and Wright, I. S.:  Studies with Crystalline Trypsin: Results and Hazards of Intravenous Administration and Its Postulated Role in Blood Coagulation , J. A. M. A. 155:347-351 ( (May 22) ) 1954;.
Ambrus, J. L.; Back, N.; Mihalyi, E.; and Ambrus, C. M.:  Quantitative Method for in Vivo Testing of Fibrinolytic Agents: Effect of Intravenous Trypsin on Radioactive Thrombi and Emboli , Circulation Res. 4:430-439 ( (July) ) 1956;.
Ambrus, J. L., and others:  Clinical and Experimental Studies on Fibrinolytic Enzymes , Ann. New York Acad. Sc. 68:97-137 ( (Aug.) ) 1957;.
Sherry, S., and Alkjaersig, N.:  Biochemical, Experimental, and Clinical Studies of Proteolytic Enzymes: With Particular Reference to Fibrinolytic Enzyme of Human Plasma , Ann. New York Acad. Sc. 68:52-66 ( (Aug. 30) ) 1957;.
Astrup, T.:  Fibrinolysis in Organism , Blood 11:781-806 ( (Sept.) ) 1956;.
Astrup, T.:  Biological Significance of Fibrinolysis , Lancet 2:565-568 ( (Sept. 15) ) 1956;.
MacFarlane, R. G., and Biggs, R.:  Fibrinolysis: Its Mechanism and Significance , Blood 3:1167-1187 ( (Oct.) ) 1948;.
Reference 3b, c, and d.
Markus, G.; Ambrus, C. M.; Whistler, F. C.; and Woernley, D. L.:  Studies on Activation of Human Plasminogen , Fed. Proc. 17:104 ( (March) ) 1958;.
Back, N.; Ambrus, J. L.; Simpson, C. L.; and Shulman, S.:  Study on Effect of Streptokinase-Activated Plasmin (Fibrinolysin) on Clots in Various Stages of Organization , J. Clin. Invest. 37:864-871 ( (June) ) 1958;.
References 6 and 2b.
Lowenberg, R. I.:  Early Diagnosis of Phlebothrombosis with Aid of New Clinical Test , J. A. M. A. 155:1566-1570 ( (Aug. 28) ) 1954;.
Urbach, F., and Noell, W. K.:  Effects of Oxygen Breathing on Tumor Oxygen Measured Polarographically , J. Appl. Physiol. 13:61-65 ( (July) ) 1958;.
Ambrus, J. L., and others: Comparative Clinical Studies of Various Preparations of Plasmin, to be published.
Loomis, E. C.; George, C., Jr.; and Ryder, A.:  Fibrinolysin: Nomenclature, Unit, Assay, Preparation and Properties , Arch. Biochem. 12:1-5 ( (Jan.) ) 1947;.
Cliffton, E. E.:  Use of Plasmin in Humans , Ann. New York Acad. Sc. 68:209-229 ( (Aug. 30) ) 1957;.
Edwards, W. S.:  Observations on Pathogenesis and Management of Massive Venous Occlusion , Surgery 43:153-163 ( (Jan.) ) 1958;.
Johnson, A. J.; Fletcher, A. P.; McCarty, W. R.; and Tillett, W. S.:  Effects in Patients of Intravenous Infusions of Purified Streptokinase Preparations , Proc. Soc. Exper. Biol. & Med. 94:254-258 ( (Feb.) ) 1957;.
Miller, J. M.:  Anti-inflammatory Effect of Intramuscular Streptokinase , Ann. New York Acad. Sc. 68:185-191 ( (Aug. 30) ) 1957;.

First Page Preview

First page PDF preview

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

Innerfield, I.:  Trypsin Given Intramuscularly in Chronic, Recurrent Thrombophlebitis , J. A. M. A. 156:1056-1058 ( (Nov. 13) ) 1954;.
Taylor, A.; Overman, R. S.; and Wright, I. S.:  Studies with Crystalline Trypsin: Results and Hazards of Intravenous Administration and Its Postulated Role in Blood Coagulation , J. A. M. A. 155:347-351 ( (May 22) ) 1954;.
Ambrus, J. L.; Back, N.; Mihalyi, E.; and Ambrus, C. M.:  Quantitative Method for in Vivo Testing of Fibrinolytic Agents: Effect of Intravenous Trypsin on Radioactive Thrombi and Emboli , Circulation Res. 4:430-439 ( (July) ) 1956;.
Ambrus, J. L., and others:  Clinical and Experimental Studies on Fibrinolytic Enzymes , Ann. New York Acad. Sc. 68:97-137 ( (Aug.) ) 1957;.
Sherry, S., and Alkjaersig, N.:  Biochemical, Experimental, and Clinical Studies of Proteolytic Enzymes: With Particular Reference to Fibrinolytic Enzyme of Human Plasma , Ann. New York Acad. Sc. 68:52-66 ( (Aug. 30) ) 1957;.
Astrup, T.:  Fibrinolysis in Organism , Blood 11:781-806 ( (Sept.) ) 1956;.
Astrup, T.:  Biological Significance of Fibrinolysis , Lancet 2:565-568 ( (Sept. 15) ) 1956;.
MacFarlane, R. G., and Biggs, R.:  Fibrinolysis: Its Mechanism and Significance , Blood 3:1167-1187 ( (Oct.) ) 1948;.
Reference 3b, c, and d.
Markus, G.; Ambrus, C. M.; Whistler, F. C.; and Woernley, D. L.:  Studies on Activation of Human Plasminogen , Fed. Proc. 17:104 ( (March) ) 1958;.
Back, N.; Ambrus, J. L.; Simpson, C. L.; and Shulman, S.:  Study on Effect of Streptokinase-Activated Plasmin (Fibrinolysin) on Clots in Various Stages of Organization , J. Clin. Invest. 37:864-871 ( (June) ) 1958;.
References 6 and 2b.
Lowenberg, R. I.:  Early Diagnosis of Phlebothrombosis with Aid of New Clinical Test , J. A. M. A. 155:1566-1570 ( (Aug. 28) ) 1954;.
Urbach, F., and Noell, W. K.:  Effects of Oxygen Breathing on Tumor Oxygen Measured Polarographically , J. Appl. Physiol. 13:61-65 ( (July) ) 1958;.
Ambrus, J. L., and others: Comparative Clinical Studies of Various Preparations of Plasmin, to be published.
Loomis, E. C.; George, C., Jr.; and Ryder, A.:  Fibrinolysin: Nomenclature, Unit, Assay, Preparation and Properties , Arch. Biochem. 12:1-5 ( (Jan.) ) 1947;.
Cliffton, E. E.:  Use of Plasmin in Humans , Ann. New York Acad. Sc. 68:209-229 ( (Aug. 30) ) 1957;.
Edwards, W. S.:  Observations on Pathogenesis and Management of Massive Venous Occlusion , Surgery 43:153-163 ( (Jan.) ) 1958;.
Johnson, A. J.; Fletcher, A. P.; McCarty, W. R.; and Tillett, W. S.:  Effects in Patients of Intravenous Infusions of Purified Streptokinase Preparations , Proc. Soc. Exper. Biol. & Med. 94:254-258 ( (Feb.) ) 1957;.
Miller, J. M.:  Anti-inflammatory Effect of Intramuscular Streptokinase , Ann. New York Acad. Sc. 68:185-191 ( (Aug. 30) ) 1957;.
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.