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Dx Fibrinolysis Treatment: Read More...


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SUMMARY::
"Clots (thrombi) develop when there is an imbalance between clot formation and clot dissolution." Medication used to prevent excess clotting are called anticoagulants.

FIBRINOLYSIS: CLOT DISSOLVING
Most medical personnel realize that there is a balance between clot (fibrin) formation and clot (dissolution) degradation.

It the chart above, CLOT DISSOLVING (fibrinolysis) is controlled by proteins released from the vessel wall that converts PLASMINOGEN to PLASMIN so that PLASMIN dissolves the clot. One way physicians attempt to dissolve a clot in the brain (stroke) or coronary vessels (heart attack) is to, in an emergency, inject the very expensive tPA.

*Coumadin®, warfarin or jantoven are the most common 'blood thinner' used for treating atrial fibrillation, the propensity for clot formation, and with some individuals with coronary artery disease or cerebral vascular accidents/strokes. They block vitamin K dependent clotting factors; factors II, VI, IX, protein C, Z.

*Plavix®/ Clopidogrel works by preventing a natural substance called adenosine diphosphate (ADP) from binding to its receptors on platelets. ADP is one of the chemicals in the body that cause platelets to clump together and start the process of blood clotting. As clopidogrel stops ADP from binding to platelets, it reduces the likelihood of clots forming in the blood.

*Heparin® directly attaches to antithrombin III (AT); this inactivates thrombin ad other proteases especially factor Xa. directly attaches to thrombi, presenting it formation into clots. Because low molecular weight LMW Heparins,Levenox® and fondaparinux target factor Xa more directly, these may reduce the risk of osteoporosis and heparin induced thrombocytopenia.

Cost Effective? Generic drugs, aspirin and persantine are equally effective as Pradaxa®.
With Plavix® 'going generic' as clopigrel does Praxada® (dabigatran) offer any benefit? The Australian physicians stated "not really"! "For preventing recurrent stroke of arterial origin, clopidogrel and the combination of aspirin and extended-release dipyridamole are equally effective and more effective than aspirin. However, limited data only support their incremental cost-effectiveness, compared with aspirin, in nondisabled patients at high risk of a recurrent ischaemic event (e.g. >20% per year) and when used for short periods (e.g. <2 years). Clopidogrel is also cost-effective for patients who are intolerant of aspirin. For preventing recurrent stroke due to atrial fibrillation, warfarin is cost-effective. Although the combination of clopidogrel and aspirin is more effective than aspirin, it is unlikely to be more cost-effective. Dabigatran is at least as effective and well tolerated as warfarin, but its eventual cost will determine its incremental cost-effectiveness."

*[Editor] The methodology the Editors use in a non-emergency situation, is a continuing protocol of weekly injections or oral dosing of anabolic steroids (stanozolol) with daily oral Metformin 500mg. second article in French. For 40-years, this has been used to deactivate Platelet Aggregation Inhibition-1 (PAI-1) as reported in the British Journal of Medicine in 1971. PAI-1 inhibits tPA and urokinase that activates Plasminogen which activates PLASMIN and dissolves clots. Presumably, since higher PAI-1 levels are seen in obesity, metabolic syndrome and cancers, "lowering PAI would lead to more rapid degeneration of fibrin clot." PAI-1 decreases 33% on the stanozolol and metformin protocol.

The American Heart Association recognizes the importance of PAI-1 as seen in their Arteriosclerosis, Thrombosis and Vascular Biology Journal showed that reductions in PAI-1 by 29% were achieved by intense life-style changes; improvement in fitness, glucose control and HDL-C were associated with decrease in PAI-1 independent of weight loss.
The editor has Case Reports where he coordinated the stanozolol/ metformin protocol with the department chairmen of hematology. The first was diabetic man with pulmonary emboli unable to take heparin; the second was a woman (drug user) with clot formation from her wrist to axilla. Both individuals remained clot free while on continuous stanozolol/ metformin therapy and were able to discontinue the medication after a period of 3-months.

Further proof of the effect of DHT derivatives on blood clotting comes from this report: "clinicians must be aware that danazol may increase the anticoagulant effect of warfarin. Patients receiving warfarin who are prescribed danazol must be monitored closely to prevent excessive anticoagulation and subsequent bleeding."

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