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Gabexate as a Therapy for Disseminated Intravascular Coagulation

Gabexate as a Therapy for Disseminated Intravascular Coagulation Abstract • The effects of gabexate mesilate on disseminated intravascular coagulation (DIC) accompanying neoplastic diseases or severe infections in ten patients were investigated and compared with those of heparin therapy in ten other patients with DIC. Of 11 patients with DIC (control) who did not receive any anticoagulation therapy for DIC, ten died of pneumonia, DIC secondary to the underlying diseases, or pulmonary edema. Heparin therapy was effective in five patients (50%), while treatment with gabexate was successful in seven patients (70%). Although the therapeutic efficacy of gabexate was not significantly different from that of heparin, in patients in whom bleeding tendencies were observed at the start of the therapy, the former was successful in four (80%) of five patients, while the latter was effective in only one (25%) of four patients treated. The results of this preliminary and nonrandomized study suggest that gabexate is as effective as heparin for the treatment of DIC, and that it may be more successful than heparin in the treatment of DIC accompanied by bleeding diathesis. (Arch Intern Med 1988;148:1409-1412) References 1. Cash JD: Disseminated intravascular coagulation , in Poller L (ed): Advances in Blood Coagulation , ed 2. New York, Churchill Livingstone Inc, 1977, pp 293-311. 2. Colman RW, Robboy SJ, Minna JD: Disseminated intravascular coagulation (DIC): An approach. Am J Med 1972;52:679-689.Crossref 3. Miller SP, Sachez-Avalos J, Stefanski T, et al: Coagulation disorders in cancer: I. Clinical and laboratory studies. Cancer 1967;20:1452-1465.Crossref 4. Didescheim P, Bowie EJ, Owen CA Jr: Intravascular coagulation-fibrinolysis (ICF) syndrome and malignancy: Historical review and report of two cases with metastatic carcinoid and with acute myelomonocytic leukemia , in Mammen ES, Anderson GS, Barnhart MI (eds): Disseminated Intravascular Coagulation . Stuttgart, West Germany, F K Schattauer, 1969, pp 215-231. 5. Feinstein DI: Diagnosis and management of disseminated intravascular coagulation: The role of heparin therapy. Blood 1982;60:284-287. 6. Drapkin RL, Gee TS, Dowley MD, et al: Prophylactic heparin therapy in acute promyelocytic leukemia. Cancer 1978;41:2484-2490.Crossref 7. Kazmier FJ, Bowie EJW, Hagedorn AB, et al: Treatment of intravascular coagulation and fibrinolysis (ICF) syndromes. Mayo Clin Proc 1974;49:665-672. 8. Diskin CJ, Weitberg AB: Minidose heparin therapy: Treatment of chronic intravascular coagulation syndrome. Arch Intern Med 1980;140:263-266.Crossref 9. Marciniak E, Gockerman J: Heparin-induced decrease in circulating antithrombin-III. Lancet 1977;2:581-584.Crossref 10. Schipper HG, Jenkins CSP, Kahle LH, et al: Antithrombin-III transfusion in disseminated intravascular coagulation. Lancet 1978;1:854-856.Crossref 11. Muramatsu M, Fujii S: Inhibitory effects of ω-guanidino acid esters on trypsin, plasmin, plasma kallikrein and thrombin. Biochim Biophys Acta 1972;268:221-224.Crossref 12. Ohno H, Kosaki G, Kambayashi J, et al: FOY: [Ethyl-p-(6-guanidinohexanoyloxy)benzoate] methanesulfonate as a serine proteinase inhibitor: I. Inhibition of thrombin and factor Xa in vitro. Thromb Res 1980;19:579-588.Crossref 13. Isobe J: Inhibitory effects of gabexate mesilate (FOY) on experimental DIC , in Fujii S, Moriya H, Suzuki T (eds): Kinins II: Systemic Proteases and Cellular Function . New York, Plenum Press, 1979, pp 385-394. 14. Brecher G, Cronkite EP: Morphology and enumeration of human blood platelets. J Appl Physiol 1950;3:365-377. 15. Quick AJ, Hussey CV, Geppert M: Prothrombin: Analytical and clinical aspects: Comparison of the one- and two-stage methods. Am J Med Sci 1963;246:517-526.Crossref 16. Clauss A: Gerinnungsphysiologische Schnellmethode zur Bestimmung des Fibrinogens. Acta Haematol 1957;17:237-246.Crossref 17. Abildgaard U, Lie M, Ødegard OR: Antithrombin (heparin cofactor) assay with 'new' chromogenic substrates (S-2238 and chromozym TH). Thromb Res 1977;11:549-553.Crossref 18. Minna JD, Robboy SJ, Colman RW: Disseminated Intravascular Coagulation in Man . Springfield, Ill, Charles C Thomas Publisher, 1974, p 207. 19. Maekawa T, Kobayashi N, Gonmori H, et al: Studies on the criteria for diagnosis of DIC (in Japanese) , in Komiya M (ed): Disseminated Intravascular Coagulation: IV. Annual Report of the Research Committee on DIC . Tokyo, Ministry of Health and Welfare of Japan, 1981, pp 4-16. 20. Davis RB, Theologides A, Kennedy BJ: Comparative studies of blood coagulation and platelet aggregation in patients with cancer and nonmalignant diseases. Ann Intern Med 1969;71:67-80.Crossref 21. Ohno H, Kambayashi J, Chang SW, et al: FOY: [Ethyl-p-(6-guanidinohexanoyloxy)benzoate] methanesulfonate as a serine proteinase inhibitor: II. In vivo effect on coagulofibrinolytic system in comparison with heparin or aprotinin. Thromb Res 1981;24:445-452.Crossref 22. Rosenberg RD: The effect of heparin on factor XIa and plasmin. Thromb Haemost 1975;33:51-62. 23. Kosaki G, Nomura T, Kambayashi J: The mechanism of the inhibitory effect of proteinase inhibitors on platelet aggregation and cellular synthesis of prostaglandins: I. The effect on the release of arachidonic acid from phospholipids. Thromb Res 1980;20:587-598.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Gabexate as a Therapy for Disseminated Intravascular Coagulation

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Publisher
American Medical Association
Copyright
Copyright © 1988 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1988.00380060173030
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Abstract

Abstract • The effects of gabexate mesilate on disseminated intravascular coagulation (DIC) accompanying neoplastic diseases or severe infections in ten patients were investigated and compared with those of heparin therapy in ten other patients with DIC. Of 11 patients with DIC (control) who did not receive any anticoagulation therapy for DIC, ten died of pneumonia, DIC secondary to the underlying diseases, or pulmonary edema. Heparin therapy was effective in five patients (50%), while treatment with gabexate was successful in seven patients (70%). Although the therapeutic efficacy of gabexate was not significantly different from that of heparin, in patients in whom bleeding tendencies were observed at the start of the therapy, the former was successful in four (80%) of five patients, while the latter was effective in only one (25%) of four patients treated. The results of this preliminary and nonrandomized study suggest that gabexate is as effective as heparin for the treatment of DIC, and that it may be more successful than heparin in the treatment of DIC accompanied by bleeding diathesis. (Arch Intern Med 1988;148:1409-1412) References 1. Cash JD: Disseminated intravascular coagulation , in Poller L (ed): Advances in Blood Coagulation , ed 2. New York, Churchill Livingstone Inc, 1977, pp 293-311. 2. Colman RW, Robboy SJ, Minna JD: Disseminated intravascular coagulation (DIC): An approach. Am J Med 1972;52:679-689.Crossref 3. Miller SP, Sachez-Avalos J, Stefanski T, et al: Coagulation disorders in cancer: I. Clinical and laboratory studies. Cancer 1967;20:1452-1465.Crossref 4. Didescheim P, Bowie EJ, Owen CA Jr: Intravascular coagulation-fibrinolysis (ICF) syndrome and malignancy: Historical review and report of two cases with metastatic carcinoid and with acute myelomonocytic leukemia , in Mammen ES, Anderson GS, Barnhart MI (eds): Disseminated Intravascular Coagulation . Stuttgart, West Germany, F K Schattauer, 1969, pp 215-231. 5. Feinstein DI: Diagnosis and management of disseminated intravascular coagulation: The role of heparin therapy. Blood 1982;60:284-287. 6. Drapkin RL, Gee TS, Dowley MD, et al: Prophylactic heparin therapy in acute promyelocytic leukemia. Cancer 1978;41:2484-2490.Crossref 7. Kazmier FJ, Bowie EJW, Hagedorn AB, et al: Treatment of intravascular coagulation and fibrinolysis (ICF) syndromes. Mayo Clin Proc 1974;49:665-672. 8. Diskin CJ, Weitberg AB: Minidose heparin therapy: Treatment of chronic intravascular coagulation syndrome. Arch Intern Med 1980;140:263-266.Crossref 9. Marciniak E, Gockerman J: Heparin-induced decrease in circulating antithrombin-III. Lancet 1977;2:581-584.Crossref 10. Schipper HG, Jenkins CSP, Kahle LH, et al: Antithrombin-III transfusion in disseminated intravascular coagulation. Lancet 1978;1:854-856.Crossref 11. Muramatsu M, Fujii S: Inhibitory effects of ω-guanidino acid esters on trypsin, plasmin, plasma kallikrein and thrombin. Biochim Biophys Acta 1972;268:221-224.Crossref 12. Ohno H, Kosaki G, Kambayashi J, et al: FOY: [Ethyl-p-(6-guanidinohexanoyloxy)benzoate] methanesulfonate as a serine proteinase inhibitor: I. Inhibition of thrombin and factor Xa in vitro. Thromb Res 1980;19:579-588.Crossref 13. Isobe J: Inhibitory effects of gabexate mesilate (FOY) on experimental DIC , in Fujii S, Moriya H, Suzuki T (eds): Kinins II: Systemic Proteases and Cellular Function . New York, Plenum Press, 1979, pp 385-394. 14. Brecher G, Cronkite EP: Morphology and enumeration of human blood platelets. J Appl Physiol 1950;3:365-377. 15. Quick AJ, Hussey CV, Geppert M: Prothrombin: Analytical and clinical aspects: Comparison of the one- and two-stage methods. Am J Med Sci 1963;246:517-526.Crossref 16. Clauss A: Gerinnungsphysiologische Schnellmethode zur Bestimmung des Fibrinogens. Acta Haematol 1957;17:237-246.Crossref 17. Abildgaard U, Lie M, Ødegard OR: Antithrombin (heparin cofactor) assay with 'new' chromogenic substrates (S-2238 and chromozym TH). Thromb Res 1977;11:549-553.Crossref 18. Minna JD, Robboy SJ, Colman RW: Disseminated Intravascular Coagulation in Man . Springfield, Ill, Charles C Thomas Publisher, 1974, p 207. 19. Maekawa T, Kobayashi N, Gonmori H, et al: Studies on the criteria for diagnosis of DIC (in Japanese) , in Komiya M (ed): Disseminated Intravascular Coagulation: IV. Annual Report of the Research Committee on DIC . Tokyo, Ministry of Health and Welfare of Japan, 1981, pp 4-16. 20. Davis RB, Theologides A, Kennedy BJ: Comparative studies of blood coagulation and platelet aggregation in patients with cancer and nonmalignant diseases. Ann Intern Med 1969;71:67-80.Crossref 21. Ohno H, Kambayashi J, Chang SW, et al: FOY: [Ethyl-p-(6-guanidinohexanoyloxy)benzoate] methanesulfonate as a serine proteinase inhibitor: II. In vivo effect on coagulofibrinolytic system in comparison with heparin or aprotinin. Thromb Res 1981;24:445-452.Crossref 22. Rosenberg RD: The effect of heparin on factor XIa and plasmin. Thromb Haemost 1975;33:51-62. 23. Kosaki G, Nomura T, Kambayashi J: The mechanism of the inhibitory effect of proteinase inhibitors on platelet aggregation and cellular synthesis of prostaglandins: I. The effect on the release of arachidonic acid from phospholipids. Thromb Res 1980;20:587-598.Crossref

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Archives of Internal Medicine – American Medical Association

Published: Jun 1, 1988

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