Clinical study
Effects of platelet suppressant, anticoagulant and fibrinolytic therapy in patients with recurrent venous thrombosis

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Abstract

Abnormalities of platelet survival time, fibrinogen survival time or fibrinolytic activity have been observed in patients with recurrent venous thrombosis. In the present study these measurements were undertaken in 41 patients with idiopathic recurrent venous thrombosis and repeated after treatment with sulfinpyrazone, ethylestrenol and phenformin or placebo. An additional 10 patients were studied before and after discontinuation of warfarin therapy. Platelet survival (autologous labelling with chromium-51) was shortened in 41 (80 percent); fibrinogen survival (autologous labelling with iodine-125) was shortened in 28 (55 per cent) and abnormal lytic activity (preocclusion and postvenous occlusion euglobulin lysis time) was present in 22 (43 per cent). All patients had at least one abnormal value, and two patients had abnormalities of all three measurements. The administration of sulfinpyrazone increased platelet survival (N = 14) but did not alter either fibrinogen survival or lytic activity. Lytic therapy (N = 7) decreased euglobulin lysis time but did not alter either platelet or fibrinogen survival, and placebo therapy (N = 11) did not alter any measurement. Discontinuation of warfarin therapy was associated with a decrease in fibrinogen survival (N = 10) but no alteration in platelet survival or lytic activity. During therapy (three months) with placebo, venous thrombosis occurred in four of 11 patients; with lytic agents, in three of seven; with sulfinpyrazone, in none of 14; and following discontinuation of warfarin therapy, in one of 10. Results suggest that abnormalities of platelet and fibrinogen survival, and of blood lytic activity are frequently observed in patients with recurrent venous thrombosis and that these measurements behave independently of each other. Platelet suppressant therapy appears to be superior to lytic therapy or to placebo therapy in preventing venous thrombosis in these patients.

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This study was supported by research funds of the Veterans Administration, and grants from the Colorado Heart Association, the National Institutes of Health (HL 16523), CIBAGEIGY Corp, Summit, NJ, and Organon BV, Oss, Netherlands. It was presented in part at the Annual Meeting, Central Society for Clinical Research, Chicago, IL, November 1976.

1

From the Division of Cardiology and Pulmonary Medicine, Denver Veterans Administration Hospital, University of Colorado Medical Center, Denver, Colorado.

Present address: Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada.

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