Defibrinogenation therapy on the peripheral vascular occlusive disease. Case report

Abstract

Batroxobin is a thrombin like enzyme originate from the snake venom of Bothrops atrox. Effects of defibrinogenation therapy using Batroxobin (Bothrops atrox marajoensis) on 2 cases of peripheral vascular occlusive diseases were reported.Case 1.The patient was a 74 year old Japanease female. She noticed a dullness or right lower extremity for 5 years. Since six months, she developed ulcers on her right toes. On January 1975, she was admitted to our hospital with intermittent claudication and ulcers of her right toes. Pulses of popliteal and dorsalis pedis artery were not palpable on the right leg. Angiography revealed occlusion of the right femoro-popliteal artery. Examination of peripheral blood and coagulation systems revealed hypercoagulable state (RBC 652×104, Ht 54%, platelet count 89.6×104, fibrinogen 600mg/dl). She was diagnosed as arteriosclerosis obliterans and thrombectomy of right femoro-popliteal artery was done. Popliteal arterial pulse could be palpable after the operation, but it was gradually decreased. The artery seemed to be rethrombosed caused by the hypercoagulability. Batroxobin (Defibrase) was given in doses of 30 to 50μl/kg/day diluted in 200ml of physiological NaCl-solution as infusion for 1 hour. RBC, Ht, and platelet count were not changed after each infusion. Fibrinogen level were decreased to 160mg/dl after 4th infusion. The maximum concentration of FDP was found 4 hours after the initial infusion of Batroxobin. Prothrombin time was not changed. Partial thromboplastin time was shortened 24 hours after initial infusion, but it returned to normal level after that. Coagulation factor II, VIII and IX were increased 24 hours after the initial infusion. These changes seemed to be related to the shortened PTT. Factor V and VII-X were not changed. Plasminogen and antiplasmin were decreased parallel. α1-antitrypsin, α2-macroglobulin and antithrombin III were not changed. Pain of her right leg was restored and she was discharged well.Case 2.The patient was a 68 year old Japanese female. She was complaining of discomfortable of her right extremity from August 1975. On October 27, she admitted to our hospital complaining of edema at her right leg. There were not any abnormal findings on the laboratory examination except fibrinogen level. Phlebography revealed thrombi in the right iliac vein. Fibrinogen level was 560mg/dl at the time of her admission.Batroxobin were given in doses of 50 to 85μl/kg 3 days before the vascular reconstruction for prevention of rethrombosis after the operation due to the hyperfibrinogenemia. The fibrinogen level was 80mg/dl at the time operation. FDP was increased markedly 4 hours after initial infusion and it gradually returned to normal concentration. Thrombectomy was done during defibrinogenation therapy. There was no bleeding during and after the operation. Defibrinogenation was continued for 4 days after the operation and fibrinogen level varied between 50 to 100mg/dl. RBC, Ht, platelet count and partial thromboplastin time were not changed. Prothrombin time was prolonged at fibrinogen level of 80mg/dl. Edema of her right leg disappeared in 19 days after the operation.