Side Effects of Thrombolytic Treatment with Porcine Plasmin and Low Dose Streptokinase

Abstract

SummaryIn the sequential thrombolytic therapy with porcine plasmin and low dose streptokinase side effects are mainly due to bleeding, intolerance reactions are less important. Treatment had to be prematurely stopped in 42 (37%) of 114 DVT cases because of severe bleeding and in 12 (10%) due to intolerance reactions. The corresponding figures for the 45 cases with arterial occlusions are 15 (33%) and 2 (4%) respectively. The intensity of systemic proteolysis as represented by the thromboplastin time is significantly correlated with haemorrhagic manifestations. Macrohaematuria and bleeding from puncture sites are the most frequent haemorrhagic complications followed by spontaneous bleeding into skin and muscles. Non-fatal intracranial bleeding occurred in 1 DVT case (0.9%) and in 2 patients with arterial occlusions (4.4%). The benefit of this potent thrombolytic regimen would greatly improve if a strong reduction of premature treatment stop could be achieved.

Focal Cerebral Ischemia: Pathophysiologic Mechanisms and Rationale for Future Avenues of Treatment

“…An important fact to note, however, is that the incidence of intracerebral hemorrhage in patients with noncerebrovascular occlusions treated with these medications is approximately 3%. 96 ' 97 In contrast, a recent report suggested that tissue plasminogen activator may lyse experimental cerebral emboli without increasing the risk of hemorrhagic infarction. 98 Despite the substantial improvement in neurologic outcome of treated animals, however, no difference in size or distribution of histologic infarction was noted between treated and control groups.…”

Identification of Patients at Risk for Anaphylaxis due to Streptokinase

“…Streptokinase Infusion.-After receiving 3,000 units of por¬ cine heparin IV, each patient with a negative skin test received 750,000 IU of streptokinase by IV infusion over a period often to 15 Accepted for publication May 13,1985 Levels of IgE to streptokinase, as determined by enzyme-linked immunosorbent assay at 1:100 serum dilution. Patient 1 had positive streptokinase skin test and was treated with urokinase for myocar¬ dial infarction.…”

Thrombolytic Therapy

“…The risks of bleeding increase with duration. 49 However, it must be kept in mind that incomplete lysis of venous thrombi will not prevent the postthrombotic syndrome.…”

“…Our successive treatment series with SK alone or combined with plasmin 48 clearly showed a rela tionship between intensity of fibrinolysis, success rate, and, unfortunately, bleeding complications. 49 It was expected that the anisoyl-protected SK-Plg complex (BRL 26,921, Beecham) would con siderably reduce the fibrinolytic effect in circulating blood. There is no doubt that this compound has a thrombolytic effect in rabbits 98 and a lower fibrino-lytic action in humans than SK.…”

“…Under systemic fibrinolytic therapy, severe bleeding, for example, intracranial bleeding, is rare yet more frequent in patients treated for arterial occlusion than in those with venous thrombosis, 49 probably because arteriopathy is not limited to the limbs. Also for these patients the sequential plasmin SK treatment results in a more intense lytic degradation of the coagulation system 47 than with either the individually titrated high dose or the SK minidose.…”