Treatment of Acute Pancreatitis with Trasylol: Report of a Controlled Therapeutic Trial

Abstract

Acute pancreatitis is a serious disease with a high mortality. The application of general medical and surgical measures such as intestinal decompression and the correction of dehydration and electrolyte imbalance has reduced this mortality signi ficantly, but more specific therapeutic measures are needed. The most widely accepted theory for the causation of acute pancrea titis at the present time is the activation of pancreatic trypsinogen with digestion of the pancreas (Forell, 1962), and the subsequent activation of potent circulatory enzymes, kalli krein and bradykinin, which may account for the severe clinical states found (Thai et al., 1963 ; Forell, 1963). If this theory is correct the possession of a potent non-toxic trypsin and kallikrein inhibitor should assist greatly in the management of this disease. Such an inhibitor was isolated from the parotid gland of cattle by Frey et al. (1950), and is now marketed as Trasylol, a polypeptide of low molecular weight capable of intravenous or intraperitoneal administration with few side effects. This drug has potent antitryptic activity in vitro (Moshal et al., 1963), and has been shown to be capable of preventing the development of experimentally induced pan creatitis in animals (McHardy et al., 1963 ; McCutcheon, 1963, 1964). However, despite widespread use in acute pancreatitis in humans it is still not possible to determine its value in the treatment of this disease, as most reports have been of un controlled clinical observations (Maurer, 1961 ; Forell, 1963 ; McHardy et al., 1963 ; Moshal et al., 1963). The only report of a double-blind study is a sentence in a review by Nardi (1963) that he found the drug of no benefit in such a trial, but that his figures were too small for statistical analysis. The purpose of this paper is to report a double-blind study of the use of this drug in acute pancreatitis of all degrees of severity treated in other respects by the usual therapeutic measures.