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ALFRED M. KEIRLE, M.D.; HELEN I. GLUECK, M.D.; JAMES C. NEELY, M.D.; WILLIAM A. ALTEMEIER, M.D.

AMA Arch Surg. 1960;81(2):311-326.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

Acute arterial obstruction must be relieved immediately to prevent gangrene. Obstruction in major vessels can be relieved surgically; however, distal thrombus propagation obstructs circulation. Small arterial thrombosis is resistant to current therapy, namely, anticoagulants to limit thrombosis and more recently enzymatic lysis of the clot.^37,49

Streptokinase,^{3,22,32,48,49} plasmin ( fibrinolysin),^{6,13,14,49,61} and chymotrypsin^34,48,49 have been used to lyse intravascular thrombi. Objective evidence that thrombi are lysed and that clinical improvement follows is frequently lacking. The thrombolytic ability of enzymes decreases after three days as the aging clot is covered with endothelium and organizes.^3,6,49 In very fresh thrombi lysis has been reported in 5 to 20 minutes.^3,14,67 Clinically this is rare and fortuitous.

The maximum safe systemic dose must be defined for each enzyme. The range between effective therapy and toxicity may be nil. Immunological phenomenon, fever, chills, hypotension, nausea, vomiting, and abnormalities of the hemopoietic and coagulation . . . [Full Text PDF of this Article]

Author Affiliations
Cincinnati

From the Departments of Surgery and Medicine, University of Cincinnati, and the Cincinnati Veterans Administration Hospital.

Footnotes
Read at the 17th Annual Meeting of the Central Surgical Association, Chicago, Feb. 19, 1960.

This study was supported in part by National Institutes of Health, Department of Health, Education, and Welfare, U.S. Public Health Service Grant H-2904, Dr. Helen I. Glueck.

Alpha Chymotrypsin was provided by Dr. J. A. Hubata and Dr. R. A. Hecht of Armour Pharmaceutical Company. We are grateful for their generosity and unlimited consultation.

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