| Abstrakt: |
In this paper attempts have been made to bring together the apparently divergent opinions of several groups of investigators. The differences seem to be largely matters of semantics and variations in methods and techniques of measurement of activity and in material available for testing rather than valid difference of opinion about the mechanisms or effectiveness of fibrinolysin. One common method of determining unitage and reporting results would solve many of our problems. Fibrinogen and inhibitor concentration is of great importance in the results of treatment with fibrinolysin. It has been established that plasmin (fibrinolysin) can dissolve thrombi in animals, and there is strong evidence that this occurs in patients. It is believed that the pyrogenic reaction to SK is the main disadvantage to fibrinolysin therapy. The dangers of hemorrhage, sensitivity reaction or spread of infection are not a serious possibility. Further attempts to develop other activators or to purify plasmin are certainly indicated. The possibility of enhancing the effect of plasmin with heparin or other agents should be actively investigated. Treatment of 76 cases with thrombotic or embolic processes has been reported. Excellent results have been obtained with venous thromboses of all stages of development. In a few cases of arterial thrombi or emboli good results have been obtained, most commonly with local treatment. With 4 mg per kg of plasmin in the dog there is significant loss of fibrinogen and some change in prothrombin. With 6 mg per kg these changes are more marked. However, in the pig, which has a very high concentration of inhibitor for human plasmin, there is practically no effect with 6.3 mg of plasmin per kg. In patients with high inhibitor levels the same effect is seen. [ABSTRACT FROM AUTHOR] |
