Kakkar V V, Scully M F
Thrombosis Research Unit, King's College School of Medicine & Dentistry, London.
Haemostasis. 1988;18 Suppl 1:127-38. doi: 10.1159/000215848.
Thrombolytic therapy has been used for treating patients suffering from a variety of clinical disorders including patients suffering from extensive venous and arterial thrombosis. This paper describes a combined approach to lytic therapy consisting of administration of small doses of streptokinase in combination with the infusion of plasminogen. The rationale for this approach is based on recent observations that additional plasminogen will be absorbed into preformed thrombi, rendering them more susceptible to lysis in the presence of activators. Forty-four patients who presented with symptoms and signs of acute or sub-acute deep vein thrombosis (DVT) confirmed by phlebography, were included in this study. Group I: 15 consecutive patients received an infusion of 600,000 units of SK dissolved in 50 ml of physiological saline over a period of half and hour. On the subsequent 4 days, a dose of 300,000 units was given twice daily. Group II: 29 consecutive patients received 60 to 90 mg of pretreated plasminogen dissolved in 50 ml of saline given intravenously over 30 min. and followed by same dosage regimen of SK. Blood samples were taken at varying intervals to assess changes in the haemostatic parameters. These were analysed for levels of alpha 2-antiplasmin, antithrombin III, fibrinogen, plasminogen, fibrinogen and degradation products, fibrinolytic activity and levels of activator complex. Findings observed will be presented. Phlebograms were performed before starting treatment and were repeated at the end of 5 days when the treatment had finished. In Group I--(15 patients)--thrombi remained virtually unchanged in 12 out of 15 patients receiving streptokinase infusion; in 3 (20%) there was partial but extensive lysis. In contrast, in Group II--(29 patients)--in 16 (55%) of 29 patients receiving plasminogen and streptokinase infusion, complete lysis of thrombi was obtained. Seven (24%) showed extensive clearance of venous tree while in remaining 6, thrombi virtually remained unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)
溶栓疗法已被用于治疗患有各种临床疾病的患者，包括患有广泛静脉和动脉血栓形成的患者。本文描述了一种溶栓治疗的联合方法，即小剂量链激酶与纤溶酶原输注联合使用。这种方法的理论依据基于最近的观察结果，即额外的纤溶酶原将被吸收到预先形成的血栓中，使其在有激活剂的情况下更容易被溶解。44例经静脉造影证实有急性或亚急性深静脉血栓形成（DVT）症状和体征的患者纳入本研究。第一组：15例连续患者在半小时内接受溶解于50ml生理盐水中的60万单位链激酶输注。在随后的4天里，每天两次给予30万单位的剂量。第二组：29例连续患者接受60至90mg预处理的纤溶酶原溶解于50ml盐水中，静脉输注30分钟，然后采用相同的链激酶给药方案。在不同时间间隔采集血样以评估止血参数的变化。分析这些样本中的α2-抗纤溶酶、抗凝血酶III、纤维蛋白原、纤溶酶原、纤维蛋白原和降解产物水平、纤溶活性以及激活剂复合物水平。将展示观察到的结果。在开始治疗前进行静脉造影，并在治疗结束的5天时重复进行。在第一组（15例患者）中，接受链激酶输注的15例患者中有l2例血栓几乎没有变化；3例（20%）有部分但广泛的溶解。相比之下，在第二组（29例患者）中，接受纤溶酶原和链激酶输注的29例患者中有16例（55%）血栓完全溶解。7例（24%）显示静脉树广泛清除，其余6例血栓几乎没有变化。（摘要截短于250字）
