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. Fibrinolysin and desoxyribonuclease both act as lytic enzymes. The combination is available as ointment containing 1 BU fibrinolysin and 666 BUs desoxyribonuclease per gram. Fibrinolysin attacks and inactivates fibrinmolecules occurring in undesirable exudates on the surface of the human body and on human mucosa, e.g., in superficial wounds and burns, while desoxyribonuclease targets and destroys 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 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. 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 Additionally, combinations with the antifibrinolytic agent tranexamic acid have been withdrawn from pharmaceutic markets.
Indications
Enzymatic wound cleaning to assist healing of minor burns, superficial wounds, ulcus cruris, and superficial hematoma.
Contraindications and Precautions
The ointment should not be used in patients with a known hypersensitivity to any ingredient. It should be used with caution in patients with hypersensitivity to bovine proteins in general and in pregnant women, because no human data is available.
Side-Effects
Infrequently, local reactions such as increased pain or a stitching/burning sensation are noticed. No systemic anticoagulant activity has been seen due to the exclusively local character of treatment.
