Fibrinolysin
Encyclopedia
Fibrinolysin is an enzyme derived from plasma of bovine origin or extracted from cultures of certain bacteria
. It is used locally only and exclusively together with the enzyme desoxyribonuclease (extracted from bovine pancreas). Fibrinolysin and desoxyribonuclease both act as lytic enzymes. The combination is available as ointment containing 1 BU (Biological Unit) fibrinolysin and 666 BUs desoxyribonuclease per gram.
Fibrinolysin attacks and inactivates fibrin
molecules occurring in undesirable exudate
s on the surface of the human body and on human mucosa, e.g., in superficial wounds and burns
, while desoxyribonuclease targets and destroys (human) DNA
. The combination of the two enzymes has a synergistic effect on necrotic but not on living tissue
. According to the manufacturer the ointment provides enhanced wound cleaning and accelerates the healing process.
Both enzymes are marginally resorbed into systemic circulation because of their very high molecular weight and their macromolecular structure.
The activity of both enzymes is almost completely exhausted after 24 hours. Usually, it is necessary to repeat the application (and renew the dressing) every 6 to 8 hours until healing becomes complete.
The ointment is marketed by Pfizer
under the brand name Fibrolan in a variety of countries (e.g. Switzerland). It is currently not approved in the USA.
Where approved, Fibrolan has been licensed on the basis of claimed good therapeutical experience, but adequate and well controlled studies are still lacking.
In the past, combinations with the antibiotic chloramphenicol
were available, but because chloramphenicol in any form of application has led to aplastic anemia
and death, these were banned. Additionally, combinations with the antifibrinolytic agent tranexamic acid
have been withdrawn from pharmaceutic markets.
.
to any ingredient. It should be used with caution in patients with hypersensitivity to bovine proteins in general and in pregnant women (category C), because no human data is available.
activity has been seen due to the exclusively local character of treatment.
Bacteria
Bacteria are a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...
. It is used locally only and exclusively together with the enzyme desoxyribonuclease (extracted from bovine pancreas). Fibrinolysin and desoxyribonuclease both act as lytic enzymes. The combination is available as ointment containing 1 BU (Biological Unit) fibrinolysin and 666 BUs desoxyribonuclease per gram.
Fibrinolysin attacks and inactivates fibrin
Fibrin
Fibrin is a fibrous, non-globular protein involved in the clotting of blood. It is a fibrillar protein that is polymerised to form a "mesh" that forms a hemostatic plug or clot over a wound site....
molecules occurring in undesirable exudate
Exudate
An exudate is any fluid that filters from the circulatory system into lesions or areas of inflammation. It can apply to plants as well as animals. Its composition varies but generally includes water and the dissolved solutes of the main circulatory fluid such as sap or blood...
s on the surface of the human body and on human mucosa, e.g., in superficial wounds and burns
Burn (injury)
A burn is a type of injury to flesh caused by heat, electricity, chemicals, light, radiation or friction. Most burns affect only the skin . Rarely, deeper tissues, such as muscle, bone, and blood vessels can also be injured...
, while desoxyribonuclease targets and destroys (human) DNA
DNA
Deoxyribonucleic acid is a nucleic acid that contains the genetic instructions used in the development and functioning of all known living organisms . The DNA segments that carry this genetic information are called genes, but other DNA sequences have structural purposes, or are involved in...
. The combination of the two enzymes has a synergistic effect on necrotic but not on living tissue
Biological tissue
Tissue is a cellular organizational level intermediate between cells and a complete organism. A tissue is an ensemble of cells, not necessarily identical, but from the same origin, that together carry out a specific function. These are called tissues because of their identical functioning...
. According to the manufacturer the ointment provides enhanced wound cleaning and accelerates the healing process.
Both enzymes are marginally resorbed into systemic circulation because of their very high molecular weight and their macromolecular structure.
The activity of both enzymes is almost completely exhausted after 24 hours. Usually, it is necessary to repeat the application (and renew the dressing) every 6 to 8 hours until healing becomes complete.
The ointment is marketed by Pfizer
Pfizer
Pfizer, Inc. is an American multinational pharmaceutical corporation. The company is based in New York City, New York with its research headquarters in Groton, Connecticut, United States...
under the brand name Fibrolan in a variety of countries (e.g. Switzerland). It is currently not approved in the USA.
Where approved, Fibrolan has been licensed on the basis of claimed good therapeutical experience, but adequate and well controlled studies are still lacking.
In the past, combinations with the antibiotic chloramphenicol
Chloramphenicol
Chloramphenicol is a bacteriostatic antimicrobial that became available in 1949. It is considered a prototypical broad-spectrum antibiotic, alongside the tetracyclines, and as it is both cheap and easy to manufacture it is frequently found as a drug of choice in the third world.Chloramphenicol is...
were available, but because chloramphenicol in any form of application has led to aplastic anemia
Aplastic anemia
Aplastic anemia is a condition where bone marrow does not produce sufficient new cells to replenish blood cells. The condition, per its name, involves both aplasia and anemia...
and death, these were banned. Additionally, combinations with the antifibrinolytic agent tranexamic acid
Tranexamic acid
Tranexamic acid is a drug used to treat or prevent excessive blood loss during surgery and in certain other conditions...
have been withdrawn from pharmaceutic markets.
Indications
Enzymatic wound cleaning to assist healing of minor burns, superficial wounds, ulcus cruris, and superficial hematomaHematoma
A hematoma, or haematoma, is a localized collection of blood outside the blood vessels, usually in liquid form within the tissue. This distinguishes it from an ecchymosis, which is the spread of blood under the skin in a thin layer, commonly called a bruise...
.
Contraindications and Precautions
The ointment should not be used in patients with a known hypersensitivityHypersensitivity
Hypersensitivity refers to undesirable reactions produced by the normal immune system, including allergies and autoimmunity. These reactions may be damaging, uncomfortable, or occasionally fatal. Hypersensitivity reactions require a pre-sensitized state of the host. The four-group classification...
to any ingredient. It should be used with caution in patients with hypersensitivity to bovine proteins in general and in pregnant women (category C), because no human data is available.
Side-Effects
Infrequently, local reactions such as increased pain or a stitching/burning sensation are noticed. No systemic anticoagulantAnticoagulant
An anticoagulant is a substance that prevents coagulation of blood. A group of pharmaceuticals called anticoagulants can be used in vivo as a medication for thrombotic disorders. Some anticoagulants are used in medical equipment, such as test tubes, blood transfusion bags, and renal dialysis...
activity has been seen due to the exclusively local character of treatment.