Intraarterial fibrinolysis: in vitro and prospective clinical evaluation of three thrombolytic agents.

Abstract

In order to investigate and compare the fibrinolytic activity of streptokinase, streptokinase-Glutamine-plasminogen, and urokinase for intraarterial fibrinolysis, as in vitro test and a prospective trial were performed. For the in vitro demonstration of lytic activity, fibrin plates with plasminogen and fibrin plates without plasminogen were incubated with streptokinase; with streptokinase-plasminogen in molar proportions of 1:1, 1:2, and 2:1, and with urokinase. In order to examine the in vivo activity of the different lytic solutions, 98 patients suffering from peripheral arterial occlusions were divided into three homogeneous groups for treatment with streptokinase, streptokinase-plasminogen, and urokinase. Although urokinase was superior to streptokinase on the fibrin plate with plasminogen, no difference was demonstrated in vivo between the two lytic agents. Streptokinase-plasminogen in a molar proportion of 1:2 showed significantly higher fibrinolytic activity than any other solution. Therefore, the fibrinolytic agent of choice for intrathrombotic injections seems to be a 1:2 solution of streptokinase with plasminogen or with the lytic enzyme plasmin itself.