Oral Fibrinolytic Enzyme Saved Pre-Gangrenous Toes -- A Single Case Study

Introduction: A 78 year-old male patient presented with dry pre-gangrenous toes wounds bilaterally that would not heal over the past 6 months, in spite of oral anticoagulant, orthotics and topical treatments.  The patient is a chronic smoker with a history of hypertension and had 2 major surgeries (triple coronary artery bypass grafting and abdominal aortic rupture repair) over the 8 months prior to the initial visit. Patient did not bring any recent laboratory test results. Functional coagulation investigation during the visit showed an sub-optimal coagulation balance and a high-normal platelet aggregating function, even though the patient is already on a standard dose of apixaban at 5mg twice daily.Methods: In order to further improve the patient's coagulation balance, tissue perfusion, and improve tissue healing, the following nutraceuticals were recommended in addition of patient's current pharmaceutical treatment: oral fibrinolytic enzyme at 2 capsules 3 times daily on an empty stomach, Vitamin C 1,000mg 3 times daily, and Magnesium 450mg in divided doses with meals.Results:Patient came back for the follow-up visit 2 weeks later, and the dry pre-gangrenous wounds on the toes were almost completely healed.Discussion: Ischemia is one of the most common etiologies in pre-gangrenous or gangrenous toes/feet, which if not treated well may lead to eventual necrosis and amputation.  Topical treatments or/and anticoagulants often have limited success. Oral fibrinolytic enzymes may be the missing link that would greatly improve the clinical outcome and should be considered.References:Olascoaga A, Vilar-Compte D, Poitevin-Chacón A, Contreras-Ruiz J. Wound healing in radiated skin: pathophysiology and treatment options. Int Wound J. 2008;5(2):246-257. doi:10.1111/j.1742-481X.2008.00436.x