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

Summary

In 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.

Keywords

Thrombolysis side effects - Low dose streptokinase - Porcine plasmin - Bleeding - Streptokinase intolerance

• References

• 1 Marbet GA, Eichlisberger R, Duckert F, da Silva MA, Biland L, Widmer LK, Ritz R, Schmitt HE. Sequential treatment of deep leg vein thrombosis with porcine plasmin and low dose streptokinase. Thromb Haemostas 1982; 48: 190-195
• 2 Marbet GA, Eichlisberger R, Duckert F, da Silva MA, Biland L, Widmer LK, Ritz R, Schmitt HE. Sequential treatment of arterial occlusions with porcine plasmin and low dose streptokinase. Thromb Haemostas 1982; 48: 187-189
• 3 Armitage P. Statistical methods in medical research. Blackwell Scientific Publications; Oxford: 1977
• 4 Verstraete M, Vermylen J, Amery A, Vermylen C. Thrombolytic therapy with streptokinase using a standard dose scheme. Br med J 1966; 1: 454-456
• 5 Hess H. Thrombolytische Therapie. Schattauer; Stuttgart: 1967
• 6 Schmutzler R. Thrombolytic treatment of acute peripheral arterial and venous occlusions. Angiologica 1968; 5: 119-129
• 7 Six P, Marbet GA, Walter M, Nyman D, Duckert F, Madar G, da Silva A, Widmer LK, Ritz R. Nebenwirkungen bei verschiedenen Thrombolysemethoden. In Neuhaus K, Duckert F. (eds) Blutgerinnung und Antikoagulation. Schattauer; Stuttgart: 1976: 111-130
• 8 Marbet GA, Walter M, Six P, Nyman D, Rüst O, Biland L, Duckert F, Madar G, da Silva A, Widmer LK, Schmitt HE, Vokal J. Vergleich verschiedener fibrinolytischer Methoden zur Behandlung venöser Thrombosen. In Neuhaus K, Duckert F. (eds) Blutgerinnung und Antikoagulation. Schattauer; Stuttgart: 1976: 98-99
• 9 Conard J, Samama M, Milochevitsch R, Horellou MH, Chabrun B, Prestat J. Complications hémorragiques au cours de 98 traitements par la streptokinase. Nouv Presse Med 1979; 16: 1219-1225
• 10 Amery A, Deloof W, Vermylen J, Verstrate M. Outcome of recent thromboembolic occlusions of limb arteries treated with streptokinase. Br Med J 1970; 4: 639-644
• 11 Duckert F, Müller G, Nyman D, Benz A, Prisender S, Madar G, da Silva MA, Widmer LK, Schmitt HE. Treatment of deep vein thrombosis with streptokinase. Br med J 1975; 1: 479-481