PDF herunterladen
Thromb Haemost 1971; 25(02): 354-378
DOI: 10.1055/s-0038-1654310
Originalarbeiten – Original Articles – Travaux Originaux
Schattauer GmbH

Studies on Thrombolysis with Streptokinase

III. Morphological Examinations of Thrombi-Thrombus Retraction and Secondary Swelling and the Termination of Lysibility because of Organization
R Gottlob
1   Department for Experimental Surgery (Head: Prof. Dr. R. Gottlob) at the First Surgical Clinic of the University of Vienna (Head: Prof. Dr. P. Fuchsig) and the Institute of Histology and Embryology of the University of Vienna (Head: Prof. Dr. A. Pischinger)
,
L Stockinger
1   Department for Experimental Surgery (Head: Prof. Dr. R. Gottlob) at the First Surgical Clinic of the University of Vienna (Head: Prof. Dr. P. Fuchsig) and the Institute of Histology and Embryology of the University of Vienna (Head: Prof. Dr. A. Pischinger)
,
U Pötting
1   Department for Experimental Surgery (Head: Prof. Dr. R. Gottlob) at the First Surgical Clinic of the University of Vienna (Head: Prof. Dr. P. Fuchsig) and the Institute of Histology and Embryology of the University of Vienna (Head: Prof. Dr. A. Pischinger)
,
G Schattenmann
1   Department for Experimental Surgery (Head: Prof. Dr. R. Gottlob) at the First Surgical Clinic of the University of Vienna (Head: Prof. Dr. P. Fuchsig) and the Institute of Histology and Embryology of the University of Vienna (Head: Prof. Dr. A. Pischinger)
› InstitutsangabenThe investigations were partially supported by a grant of the scientific foundation of the Community of Vienna.
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
28. Juni 2018 (online)

    Lizenzen und Reprints

Summary

In vitro whole blood clots of various ages, experimental thrombi produced in the jugular vein of rabbits and human thrombi from arteries and veins were examined in semi-thin sections and by means of electron microscopy.

In all types of clots examined a typical course of retraction was found. Retraction starts with a dense excentrical focus which grows into a densification ring. After 24 hours the entire clot becomes almost homogeneously dense; later a secondary swelling sets in.

Shortly after coagulation the erythrocytes on the rim of the clot are bi-concave discs. They then assume the shape of crenate spheres, turn into smooth spheres and finally become indented ghosts which have lost the largest part of their contents. In the inner zone, which makes up the bulk of the clot, we observed bi-concave discs prior to retraction. After retraction we see no crenations but irregularly shaped erythrocytes. Once the secondary swelling sets in, the cross-section becomes polygonal and later spherical. After extensive hemolysis we observe the “retiform thrombus” made up of ghosts.

Experimental and clinical thrombi present the same morphology but are differentiated from in vitro clots by: earlier hemolysis, immigration of leukocytes, formation of a rim layer consisting of fibrin and thrombocytes, and the symptoms of organization. Such symptoms of organization which definitely will prevent lysis with streptokinase were found relatively late in experimental and clinical thrombi. Capillary buds and capillary loops were never found in clinical thrombi prior to the third month.

The morphological findings agree with earlier physical and enzymatic investigations. The observation that phenomena of reorganization occur relatively late and frequently only in the rim areas of large thrombi explains why lytic therapy is possible in some of the chronic obliterations.

 

  • References

  • 1 Adlkofer F, Ketnath H. J, Uher L, Ruhenstroth-Bauer G. Der Mechanismus der Blutkörperchensenkung. XIV : Der Einfluß von Lysolezithin und unveresterten Fettsäuren auf die Blutkörperchensenkungsgeschwindigkeit. Blut 19: 321 1969;
    CrossrefPubMedGoogle Scholar
  • 2 Beneke G. Die Pathologie der venösen Gefäße und der venösen Durchblutungsstörungen. Hippokrates (Stuttg.) 40 (40) 325 1969;
    PubMedGoogle Scholar
  • 3 Benehe G. Der Thrombus als pathologisch-anatomisches Substrat. Therapeutische und experimentelle Fibrinolyse. (Internat. Symposion 29.9. - 1.10.1967, Ulm). Schattauer-Verlag F. K. Stuttgart; New York: 1969
    Google Scholar
  • 4 Brass K. Aufbau und Entstehung der Beinvenenthrombose. Frankf. Z. Path 56: 74 1942;
    PubMedGoogle Scholar
  • 5 Ehringer H, Fischer M. Erfolgreiche thrombolytische Therapie bei subakuten arteriellen Thrombosen. Med. Welt 1968; 1726.
    PubMedGoogle Scholar
  • 6 Erpenbeck E, Noetzel H. Gefäß- und Parenchymveränderungen des Gehirns bei Embolien im Tierexperiment. Beitr. path. Anat 124: 376 1961;
    PubMedGoogle Scholar
  • 7 Filshie J. The organization of experimental venous thrombi. J. Path. Bact 76: 71 1958;
    CrossrefPubMedGoogle Scholar
  • 8 Flanc G. An experimental study of the recanalization of arterial and venous thrombi. Brit. J. Surg 55: 519 1968;
    CrossrefPubMedGoogle Scholar
  • 9 Gottlob R, Blümél G. Warum lassen sich Yollblutgerinnsel mit Streptokinase nur unvollständig auflösen ? Klin. Med 19: 405 1964;
    PubMedGoogle Scholar
  • 10 Gottlob R, Blümel G. Untersuchungen zur Thrombolyse in vitro. Klin. Med 20: 353 1965;
    PubMedGoogle Scholar
  • 11 Gottlob R, Blümel G. Über den Nachweis der Plasminogenverarmung in retrahierten Vollblutgerinnseln und über deren Bedeutung für die Lysierbarkeit mit Streptokinase. Thrombos. Diathes. haemorrh. (Stuttg) 15: 570 1966;
    PubMedGoogle Scholar
  • 12 Gottlob R, Blümel G, Piza F, Brücke P, Böhmig H. J. Die Lysierbarkeit operativ gewonnener menschlicher Thromben verschiedenen Alters in Streptokinase. Wien. med. Wschr. 118 222 1968
    Google Scholar
  • 13 Gottlob R, Blümel G, Piza F, Brücke P, Böhmig H. J. Studies on Thrombolysis with Streptokinase II. The Influence of Changes due to Age in Thrombi and Whole Blood Clots. Thrombos. Diathes. haemorrh. (Stuttg) 19: 516 1968;
    PubMedGoogle Scholar
  • 14 Gottlob R, Blümel G. Der Einfluß der vier Thrombenalter auf die Lysierbarkeit mit Streptokinase. Die Mediz. Welt 48 (19) 2627 1968;
    PubMedGoogle Scholar
  • 15 Gottlob R, Blümel G. Mechanismen der Thrombolyse mit Streptokinase bei Thromben verschiedenen Alters. Therapeutische Fibrinolyse. (Internat. Symposion 29.9. - 1.10.1967, Ulm) Verlag F. KSchattauer. 1969: 207-212.
    Google Scholar
  • 16 Hess H. Collective statisticsin »Thrombolytische Therapie«. Symposion der Deutschen Gesellschaft für Angiologie. 4. und 28.10.1966. Jahrestagung, München. 27 Schattauer-Verlag F. K. Stuttgart; New York: 1967
    Google Scholar
  • 17 Irninger W. Histologische Altersbestimmung von Thrombosen und Embolien. Yirch. Arch, path. Anat 336: 220 1963;
    PubMedGoogle Scholar
  • 18 Marin H. M, Stefanini M. Experimental production of phlebothrombosis. Surg. Gynec. Obstet 110: 263 1960;
    PubMedGoogle Scholar
  • 19 Martin M, Schoop W, Zeitler E. Erfolgreiche Streptokinasebehandlung bei chronisch-arterieller Verschlußkrankheit. Herz Kreislauf 01: 31 1969;
    PubMedGoogle Scholar
  • 20 Mavor G. E, Bennett B, Galloway J. M. D, Karmody A. M. Streptokinase in Ileofemoral Venous Thrombosis. Brit. J. Surg 56: 564 1969;
    CrossrefPubMedGoogle Scholar
  • 21 Möller P. Studien über embolische und autochthone Thrombose in der Arteria pulmonalis. Beitr. path. Anat 71: 27 1923;
    PubMedGoogle Scholar
  • 22 Pederson H. J, Tebo T. H, Johnson S. A. Evidence of Hemolysis in the Initiation of Hemostasis. Amer. J. clin. Path 48: 1 1967;
    PubMedGoogle Scholar
  • 23 Piza F, Gottlob R, Blümel G. Zur Frage der Retraktion intravital entstandener Blutgerinnsel. Klin. Med 22: 97 1967;
    PubMedGoogle Scholar
  • 24 Poliwoda H, Alexander K, Buhl V, Holsten D, Wagner H. Treatment of Chronic Arterial Occlusions with Streptokinase. New Engl. J. Med 280: 689 1969;
    CrossrefPubMedGoogle Scholar
  • 25 Rössle R. Über die Bedeutung und Entstehung der Wadenvenenthrombose. Virch. Arch. path. Anat 300: 180 1937;
    CrossrefPubMedGoogle Scholar
  • 26 Sandritter W, Beneke G. Thrombose. In: Kaufmann E, Staemmle M. Lehrbuch der speziellen pathologischen Anatomie. Ergänzungsband I, 1. Hälfte, 3. Lieferung. W. De Gruyter u. Co; Berlin: 1968
    Google Scholar
  • 27 Schoop W, Martin M, Zeitler E. Beseitigung von Stenosen in Extremitätenarterien durch intravenöse Streptokinasetherapie. Dtsch. med. Wschr 93: 1629 1968;
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 28 Scott G. B. D. A quantitative study of the facts of occlusive red venous thrombi. Brit. J. exp. Path 49: 544 1968;
    PubMedGoogle Scholar
  • 29 Scott B. D, Gracey L. R. H. Analysis of the Factors Concerned in the Organization of Occlusive Thrombi. Arch. Path 87: 643 1969;
    PubMedGoogle Scholar
  • 30 Semsroth M. In vitro Untersuchungen zur Thrombolyse mit verschieden enthrombolytisch wirksamen Substanzen. Inaugural-Dissertation (Thesis) an der Ludwig-Maximilians-Universität zu München. 1970
    PubMedGoogle Scholar
  • 31 Sinapius D, Gunhel R. D. Die Verfettung parietaler Thromben der Aorta und ihre Bedeutung für die Atherosklerose. Virch. Arch. path. Anat 337: 353 1964;
    CrossrefPubMedGoogle Scholar
  • 32 Still W. J. S, Ghani A. R, Dennison S. M. The organization of isolated mural thrombi in aortic grafts. An electron microscopic study. Amer. J. Path 51/11: 1013 1967;
    PubMedGoogle Scholar
  • 33 Stirling G. A, Tsapagos M. J, Girolanis P. L. Organization of thrombi. Brit. J. Surg 53: 232 1966;
    CrossrefPubMedGoogle Scholar
  • 34 Wessler S. t, Ward K, HO G. Studies in intravascular coagulation. J. clin. Invest 34: 647 1955;
    CrossrefPubMedGoogle Scholar
  • 35 Williams G. Experimental arterial thrombosis. J. Path. Bact 69: 199 1955;
    CrossrefPubMedGoogle Scholar
  • 36 Zollinger H. U, Hensler L. Die alte massive Lungenembolie. Schweiz, med. Wschr 88: 1227 1958;
    PubMedGoogle Scholar