batroxobin + low molecular weight heparin

A combination therapy consisting of batroxobin, a thrombin-like serine protease extracted from Bothrops atrox moojeni venom, and low molecular weight heparin (LMWH), a class of anticoagulants derived from unfractionated heparin. This combination is primarily used for treating cerebral venous thrombosis (CVT). **Mechanism of Action**: Batroxobin acts as a defibrinogenating agent by degrading insoluble fibrinogen, dissolving soluble fibrin, and inhibiting platelet aggregation. It significantly decreases fibrinogen levels while increasing D-dimer values, indicating enhanced fibrinolysis. LMWH functions as an anticoagulant primarily by binding to antithrombin and catalyzing the inactivation of factor Xa, with reduced ability to inactivate thrombin. Together, the combination has shown beneficial effects including inhibition of ADP-induced platelet aggregation, increased D-dimer levels, decreased fibrinogen levels, and prolonged thrombin time (TT) and activated partial thromboplastin time (APTT). **Clinical Applications**: The primary application is in the treatment of cerebral venous thrombosis (CVT), where it may promote venous sinus recanalization, attenuate CVT-induced stenosis, reduce time to symptom relief, and decrease recurrence rates. The combination has also been studied for deep vein thrombosis (DVT), showing reduction in fibrinogen levels, improvement of symptoms, and increased recanalization rates.