Agents that Interfere with Coagulation

Therapeutic agents that interfere with blood coagulation fall into four classes  

Anticoagulants, which include heparin and the coumadin-inanedione oral anticoagulants 

Thrombolytic agents such as streptokinase, urokinase, and recombinant tissue-type plasminogen activator 

Antiplatelet drugs, which alter the aggregating ability of platelets 

Defibrinogenating agents, which remove the fibrinogen from circulating blood 

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Thrombolytic agents interfere with the measurement of plasma fibrinogen and other coagulation tests by promoting continuing fibrinolysis after the specimen is taken thus, fibrinogen cannot be measured in a sample that is taken less than an hour after the administration of a thrombolytic agent. 

The studies mentioned above indicate that bromelain has a certain cytotoxic potential. It remains an open question whether the observed antineoplastic effects of bromelain preparations reside in the proteolytic enzyme or in some or more other components of the mixture. Before the work of Maurer et al. [104] and of Batkin et al. [105], the antitumor activity of bromelain was explained primarily by its fibrinolytic and platelet aggregation inhibitory activity, which is believed to interfere with the fibrin and coagulation features of tumor cells [2], More recently, Desser and Rehberger [107] demonstrated that bromelain stimulates the production of alpha tumor necrosis factor in human peripheral blood mononuclear cell cultures in a time-dependent manner. Immunomodulation, especially the release of cytokines, is believed to be responsible for the possible therapeutic potential of bromelain. However, further experimental evidence is necessary, first, to prove the antineoplastic action of the proteolytic enzyme, and second, to demonstrate that bromelain in vivo is a valuable therapeutic agent in humans. 

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