Does a Hemorrhagic Tendency Exist in Patients Under Isoniazid-Streptomycin Treatment?

¹ Molly Stark Hospital, Canton, Ohio.

1. Two hundred eighty-seven patients with pulmonary tuberculosis were studied in order to determine whether isoniazid-streptomycin increases the hemorrhagic tendency. Eight per cent of the patients developed hemoptysis or streaking, 5.2 per cent of these have also had hemoptic episodes before initiation of treatment, 2.8 per cent for the first time. Fifty-nine were admitted with history of hemoptysis and 33 admitted because of hemoptysis. Only 15 of the 92 (16.3 per cent) developed hemoptysis while under treatment and most of them in the first trimester of treatment. In the eight (2.8 per cent) who developed hemoptysis for the first time while under treatment, bleeding could have occurred due to the nature of the disease—all of them were far advanced cases, three with silico-tuberculosis—or explained by unusual activity, drinking, etc.—and not necessarily due to action of isoniazid. Apparently the drug definitely decreased the incidence of hemoptysis in tuberculous patients.

2. No other bleeding (renal, rectal etc.), attributable to chemotherapy, was noted during the study.

3. There was a normal incidence of operative and postoperative bleeding with one exception, where the mechanism was not determined.

4. Laboratory study of clotting, bleeding and prothrombin time and of platelets count before and during treatment showed a variation within physiological limits without any definite trend or pattern.

5. Capillary fragility was normal in 79.2 per cent and increased in 20.8 per cent, However, only in 12.5 per cent there was no definite explanation for the increase of fragility and in these cases chemotherapy could be considered as one of the possible factors. Further studies are suggested.