Arthur J. Seaman

Deep Vein Thrombosis Treated With Streptokinase or Heparin Follow-Up of a Randomized Study

Twenty-seven patients with deep vein thrombosis whose primary therapy was randomized between streptokinase and heparin were reevaluated clinically and by ascending venography after a mean period of 7 months. Normal venograms were found in 6 (40%) of the streptokinase-treated patients and in 1 patient (8%) who had heparin therapy. Segmental valve preservation was found in 1 patient from each group. All patients with complete or partial valve preservation became asymptomatic. Vein re canalization without preservation of valves occurred in 18 patients: 8 (54%) of those on streptokinase, and 10 (83%) of those on heparin. At the time of follow-up, 11 of these 18 patients, including 8 who had had prior thrombosis, reported peripheral edema; the postphlebitic syndrome devel oped in 1. Factors favoring a good outcome of acute venous thrombosis were (1) no prior thrombotic disease, (2) localized thrombosis, and (3) prompt streptokinase therapy.

Streptokinase Treatment of Thromboembolic Disease

Abstract Seventeen patients were treated with streptokinase for thromboembolic disorders. This material appears to offer an improvement in therapy in selected cases. Fibrinolytic therapy seems to be of greatest value in patients with fresh clots; it is ineffective in the presence of clot organization. Further trial, including an exploration of the possible use of streptokinase for selective clot lysis, is warranted.

Streptokinase and Heparin in the Treatment of Pulmonary Embolism: A Randomized Comparison

Treatment with streptokinase followed by heparin was compared on a randomized basis with treatment with heparin alone in patients with acute pulmonary embolism. The diagnosis and results of treatment were established by pulmonary angiography. Fifteen patients received streptokinase and 16 received heparin alone. Complications included bleeding and pyrexia in both treatment groups and anaphylaxis in a patient receiving streptokinase. There were three deaths attributed to the disease its treatment. Patients in the strepto kinase group had significantly greater angiographic improvement (P = 0.0125) than those in the heparin group.

Long-Term Anticoagulant Prophylaxis after Myocardial Infarction

Abstract In a double-blind, randomized test, long-term prophylactic anticoagulant therapy after acute myocardial infarction did not reduce mortality rate or complications. More treated patients required hospitalization than patients not receiving anticoagulant drugs. Patients continuously entered the study between 1956 and 1967. The average period at risk was about six years. All patients received six weeks of anticoagulant therapy for initial episodes of infarction, and, time and circumstances permitting, for recurrent myocardial infarctions.

Comparative survival times of x-ray treated versus P32 treated patients with chronic leukemias under the program of titrated, regularly spaced total-body irradiation.

In the period from January 1941 to July 1951, treatment of 163 patients with chronic leukemia by the method of titrated, regularly spaced total-body irradiation (1, 2) was started. The basic principles of treatment were identical for all of these patients, but some were given spray roentgen irradiation and others internal irradiation by intravenously injected radioactive phosphorus (P32). No difference between the clinical response to x-ray irradiation and to P32 was noted. A comparison was made of the survival times of the two groups to determine if spray irradiation by x-rays offers a better prognosis than equivalent internal irradiation by radioactive phosphorus. Leukemia is a completely disseminated neoplasm, with infiltration of all organs and tissues. It has repeatedly been observed that the feeling of well-being of the patient with this disease is maximal when leukocytosis, hepatomegaly, splenomegaly, anemia, and lymphadenopathy are minimal. To reach all neoplastic cells, total-body irradiation sho...

An overview of anticoagulant therapy for coronary artery disease

Abstract From animal experiments it appears that anticoagulant therapy can indeed be antithrombotic, both with regard to venous and to arterial occlusion. Anticoagulant therapy has proved valuable in human venous thrombotic disease, but its value in arterial thrombotic disease is still in doubt. Even those studies of the effect of anticoagulant therapy upon human acute myocardial infarction which have not demonstrated any advantage with regard to mortality rates frequently have confirmed simultaneously the venous antithrombotic effectiveness of such treatment. The inference seems to be that other aspects of this disease and of its treatment (antishock measures, better fluid and electrolyte balance, etc.) are more important with regard to life and death than is anticoagulant therapy and reduced thromboembolism. The level of hypocoagulability comparable to that required for animal arterial antithrombosis may be incompatible with long-term human ambulatory therapy. This is not known for certain at present. Bjerkelunds and the British Medical Research Council studies would seem to indicate some transient protection for persons—possibly only men—under sixty years of age. The uncertainty exists because the present methods most widely used for anticoagulant control almost certainly measure neither the events responsible for antithrombosis nor the induced coagulation defect causing hemorrhage. Instead, they measure an associated phenomenon and only imperfectly and indirectly reflect those which we should like to measure. One certain conclusion can be drawn at present. Not only are more objective studies of the value of short- or long-term anticoagulant therapy as an arterial antithrombotic regimen morally justifiable, they are indispensable. Additionally, the value of control methods such as the siliconized tube clotting time or the degree of platelet adhesiveness may prove to be more accurate reflections of the events we wish to measure than the currently used prothrombin time. An imaginative and clinically applicable technic for measurement of antithrombotic and hemorrhagic risk may follow when further experimental studies clarify our knowledge of the fundamental nature of the mechanism of thrombosis. A technic of utilization of anticoagulant drugs then may be possible that will afford effective prophylaxis against arterial thrombosis. More and more, with present technics, it seems wisest to respect the reluctance of Rytand [18], Evans [1], Russek and Zohman [26], McMichael and Parry [52], Honey and Truelove [48], and others [134–136] to accept anticoagulant therapy as the unqualified treatment of choice for coronary artery disease.

Cardiac catheterization during anticoagulant therapy

Abstract Sixty-three patients receiving anticoagulant therapy with sodium warfarin underwent cardiac catheterization with prothrombin-proconvertin values between 4 and 30 percent. The anticoagulant dose was omitted the day before and resumed the evening of catheterization. Procedures included 43 right heart studies by venous cutdown, 26 transseptal left heart catheterizations, 42 percutaneous retrograde femoral arterial catheterizations, 8 transthoracic cardiac punctures and 55 percutaneous brachial arterial catheterizations. In 1 patient left hemothorax developed after transthoracic cardiac puncture. In a second minor bleeding from the femoral arterial puncture site occurred after premature ambulation. No extensive bleeding or difficulty in obtaining hemostasis occurred. Cardiac catheterization can be performed with reasonable safety during anticoagulant therapy with the prothrombin-proconvertin time in the therapeutic range. Problems in reestablishing anticoagulant control are avoided, and the patient is not exposed to the increased risk of thromboembolic complications incurred with interrupted therapy.

Coagulation studies of patients with abnormal uterine bleeding

Abstract Forty-three patients with functional uterine bleeding were examined. Six showed evidence of a hemorrhagic diathesis with the following findings: all had prolongation of the bleeding time; 4 had prolonged partial thromboplastin times and, of these, 3 exhibited abnormal thromboplastin generation, one demonstrating a plasma factor defect and the other 2 a serum factor defect; 2 patients had fibrinogenopenia; no abnormalities were demonstrated by the Quick time, the P and P time, or the clot retraction test. There was a positive family history of bleeding in 3 of the patients with hemorrhagic diathesis. Three of the 4 patients undergoing surgical procedures needed transfusions to control postoperative bleeding. Five of the 6 patients with hemorrhagic diathesis demonstrated either a positive family history and/or a personal need for transfusions to control postoperative bleeding. Three (of 3) patients with hemorrhagic diathesis had normal pregnancies, delivered normal viable infants, and experienced no postpartum hemorrhage.

Late, Heparin-Induced Bleeding after Retrograde Arterial Catheterization

Three patients with ball-valve prostheses were given heparin after percutaneous retrograde aortic catheterization from the femoral artery. The drug was given prophylactically in one case and because of the development of signs of systemic embolism soon after catheterization in the other two. After 3 or more days of heparin therapy, serious bleeding developed at the site of percutaneous catheter entry. The timing and incidence of this complication are in marked contrast to experience with this procedure in individuals who did not receive heparin.Preliminary experience is presented from right and left heart catheterizations in patients whose prothrombin-proconvertin times were allowed to remain in or near the therapeutic range. No hemorrhagic complications were observed.

Cryoglobulinemia: Rationale of treatment of a case based on unusual properties of the cryoprotein

Abstract The studies of a forty-eight year old man who has a cryoglobulin with unique properties are presented herein. The cryoglobulin polymerizes to form a gel which interferes with the blood clotting test systems, causes increased blood viscosity, and slows peripheral circulation. The mechanism of these effects is related to hydrogen bond formation, which can be prevented in vivo and in vitro by basic organic amines. The protein has a long turnover time with a half-time of 18.8 days. It is related immunologically to gamma globulin but also has a specific immunologic reaction. Nitrogen balance studies showed a decrease in the concentration of cryoglobulin when the patient was in negative nitrogen balance. Removal of the abnormal protein by plasmapheresis resulted in lowering of the concentration from 9.5 to 4 to 5 gm. per cent and correction or improvement of all abnormal clinical and laboratory findings.