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[Indications and contraindications for protease inhibitors]
Schweizerische Medizinische Wochenschrift
|September 13, 1975
Summary
Protease inhibitors are now contraindicated for bleeding due to disseminated intravascular clotting, but show promise in treating acute pancreatitis and congenital deficiencies. Further research is ongoing for various indications.
Area of Science:
- Biochemistry
- Pharmacology
- Hematology
Context:
- Historically, protease inhibitors were considered for bleeding disorders attributed to primary hyperfibrinolysis.
- Advancements in diagnostics revealed disseminated intravascular clotting (DIC) with consumption coagulopathy as the cause of many bleeding diatheses.
- Protease inhibitors are contraindicated in DIC due to the risk of exacerbating clotting.
Purpose:
- To review the evolving clinical applications and contraindications of protease inhibitors.
- To highlight established and emerging therapeutic uses of protease inhibitors.
- To discuss the role of inhibitors in managing bleeding disorders and congenital deficiencies.
Summary:
- Clinical use of protease inhibitors has shifted from treating presumed hyperfibrinolysis to recognizing their contraindication in DIC.
- Controlled trials support their use in essential hypermenorrhea and post-prostatectomy hematuria.
- Recent evidence demonstrates a protective effect of aprotinin in acute pancreatitis.
- Substitutive therapy with exogenous or synthetic inhibitors is beneficial for congenital deficiencies like alpha1-antitrypsin and C1-esterase-inhibitor deficiencies.
Impact:
- Clarifies the appropriate use of protease inhibitors, preventing potential harm in DIC.
- Identifies specific conditions where protease inhibitors offer therapeutic benefits.
- Suggests potential for new therapeutic strategies in pancreatitis and inherited inhibitor deficiencies.