Defibrinogenation therapy in the peripheral vascular occulsive disease (III)

Abstract

Defibrinogenation therapy is expected to be a new type of anticoagulant therapy without serious bleeding complications. However, it appears to be dangerous to perform surgical procedure in the defibrinogenated state.In order to investigate the causes of the bleeding tendency which occurs during defibrinogenation therapy, the following clinical study was undertaken.Twelve patients were treated with Batroxobin (Bothrops atrox moojeni and marajoensis). Eight out of 12 patients were suffering from venous thrombosis of ilio-femoral vein. Another 2 patients were suffering from arteriosclerosis obliterans (ASO). And finally, 2 patients were suffering from cerebral artery thrombosis.Batroxobin was given in doses of 30 to 115μl/kg/day diluted 200 to 500ml of phisiological NaCl-solution as intravenous infusion for 2 to 8 hours. Eight out of 12 patients were treated concervatively with Batroxobin and Urokinase. On the other 4 patients, surgical procedure was performed during defibrinogenation therapy.On 8 patients who were treated concervatively with Batroxobin and Urokinase, Red blood cell and platelet counts were not changed. Plasma fibrinogen concentration decreased between 40 to 80mg%. FDP level tended to be moderate after the 3rd or 4th infusion. Platelet adhesiveness and ADP-induced platelet aggregation was not decreased markedly. No bleeding complications were found. The other 4 patients were operated during defibrinogenation therapy. Red blood cell, platelet counts, platelet adhesiveness, and ADP-induced platelet aggregation were not changed. Fibrinogen concentration ranged between 0 and 80mg% at the time of the operation. There was no bleeding tendency on these patients with the exception of patient No. 12.Tracheostomy was performed as an emergency measure on the patient No. 12, 3 hours after the end of the Batroxobin infusion (It is not considered the Batroxobin to have played any causative role). Fibrinogen concentration was decreased beyond measure ability during and after the operation. There was severe bleeding from the wound.It is concluded from these results as follows:(1) Platelet adhesion to the grass and ADP-induced platelet aggregation are not influenced extremely by the decreased fibrinogen concentration during the defibrinogenation therapy.(2) Batroxobin could be used as a conservative therapeutic drug without haemorrhagic risk even if fibrinogen concentration is markedly decreased.(3) To insure haemostasis, it is necessary to control the fibrinogen concentration above 60mg% during and after the operation.