Therapeutic thrombolysis in cerebral thromboembolism

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Abstract
A double-blind evaluation of plasmin (throm-bolysin) therapy was carried out in 40 patients with 72 hours of the onset of a stroke. Treatment consisted of 200,000 units of thrombolysin or "placebo" infused over a 6-hour period daily for 3 days. All cases were assessed clinically before treatment and again at 10 days after therapy. Comparison of treated cases with those receiving placebo showed no significant difference between the 2, with the exception of possible benefit in patients over 65 years of age receiving plasmin. Arteriography carried out before and after treatment demonstrated clot lysis in 1 case in each group, indicating an active, naturally occurring fibrinolytic system in patients with an acute stroke. Biochemical studies showed that in all improved patients the naturally occurring antiplasmin was generally reduced as was plasminogen, while fibrinogen approached or reached normal levels. Many clinically improved subjects showed more active fibrinolysis than normals. In the plasmin-treated group, there was good evidence of activation of plasminogen to plasmin. A rising fibrinogen level during therapy was usually indicative of a poor response to treatment or death.

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