Observations of enzyme elevations in the serum during streptokinase treatment.

in cerebrovascular disease is presently available. Of the two statistically controlled therapeutic trials that have been published, the first with a plasmin/ streptokinase mixture (Thrombolysin) suggested that the treatment was without value, while the second trial of streptokinase plus anticoagulants versus a control group of anticoagulant-treated patients suggested that though lysis of the causative thrombus occurred more frequently in the treated than in the control group, judged by mortality and morbidity criteria, the treated group responded less well to therapy than did the control group. However, for various well known reasons, strepto-kinase is a far from ideal drug for use in acute cerebrovascular disease and serious exploration of the potential of thrombolytic therapy in this area required the availability of a superior thrombolytic agent such as urokinase. Urokinase therapy does not appear to present any special difficulty or hazard in the patient with acute cerebrovascular disease. Urokinase dosage requirements , calculated on a patient bodyweight basis, are similar to those of patients suffering from other thromboembolic disease states. High levels of plasma thrombolytic activity are induced by the therapy with only minimal disturbance to blood coagulation function. Clinically, no unusual haemorrhagic phenomena were observed except that, similarly to other patients treated with urokinase, haemorrhage sometimes occurred at surgical incision sites or at sites of recent arterial catheter insertion. While no valid assessment of urokinase therapeutic effect can be made with this small number of stroke patients, it should be mentioned that there was only one death (not attributable to the treatment). Deterioration of patients during the time of treatment infusion was not observed, and, five patients suffering from severe venous sinus thrombosis recovered following therapy, in three instances, with apparently unusual rapidity and completeness. These findings suggest that a larger trial of urokinase therapy in acute cerebrovascular disease is certainly feasible and should be undertaken. Side effects of fibrinolytic therapy with streptokinase are well known. Casual observations of enzyme elevations in the serum of patients with chronic arterial obstruction of the lower extremities during streptokinase treatment (Martin, Schoop, and Zeitler, 1969) suggested that a planned study of 24 unselected patients should be performed The enzymes were chosen with regard to their value in differentiating distinct cellular lesions: the amino transferases (GOT and GPT), together indicating disturbed permeability of liver cells, the mitochondrial glutamate dehydrogenase (GLDH) as an index of severe cellular damage, alkaline phosphatase (SAP) and y-glutamyl transpeptidase (GGTP) for …