A Prospective Study of Streptokinase and Heparin in the Treatment of Deep Vein Thrombosis

Abstract

ABSTRACT. In a prospective trial, 42 medical patients with a history of deep vein thrombosis of less than five days were allocated at random to treatment with streptokinase or heparin. Only patients with extensive thromboses were included. Streptokinase was given in a loading dose of 250000 IU and a maintenance dose of 100000 IU/hour for 4 days as a mean. Heparin was given in a loading dose of 15 000 IU and a maintenance dose of 20000–50000 IU/day. The therapeutic results were evaluated by phlebography. Significant thrombolysis occurred in 71.4% of 21 patients treated with streptokinase and in 23.8% of the 21 heparin‐treated patients. Using the X2‐test for overall association, this difference was statistically highly significant (p=0.002). Three patients in each treatment group experienced major bleeding, two in each group requiring blood transfusions. Minor bleeding and slight rise in temperature were encountered more often in the streptokinase than in the heparin group. It is concluded that patients with acute deep vein thrombosis with proximal extension of the thrombus beyond the calf veins should be offered a therapeutic trial with streptokinase.

Catheter‐directed thrombolysis (intrathrombus injection) in treatment of deep venous thrombosis: A systematic review

“…opening of occluded veins was accomplished more frequently with catheter-directed thrombolysis alone (90%) [18] or with catheter-directed thrombolysis often followed by adjunct therapy (76%) [9,10,[19][20][21] than with a systemic infusion (28%) [3,[25][26][27] or localregional administration (20%) [3]. Any early thrombolysis also occurred at higher rates with catheter-directed administration [1,18] and catheter-directed administration often followed by adjunct therapy [19,22] than with systemic [3,[23][24][25][26][27] or local-regional [3] administration (Tables I and II). The prevalence of postthrombotic syndrome also was lower, 27%, with catheterdirected administration often followed by adjunct therapy [20][21][22] compared with 57% [3,23] and 72% [3,5] (Table II).…”

“…Any early thrombolysis also occurred at higher rates with catheter-directed administration [1,18] and catheter-directed administration often followed by adjunct therapy [19,22] than with systemic [3,[23][24][25][26][27] or local-regional [3] administration (Tables I and II). The prevalence of postthrombotic syndrome also was lower, 27%, with catheterdirected administration often followed by adjunct therapy [20][21][22] compared with 57% [3,23] and 72% [3,5] (Table II). Any bleeding with catheter-directed thrombolytic therapy alone occurred in 6 of 20 (30%) [1,18] and with catheter-directed followed by adjunct therapy any bleeding occurred in 49 of 163 (30%) [10,[19][20][21][22] compared with 40 of 248 (16%) with systemic infusions [3,[23][24][25][26][27]] and 7 of 146 (5%) with local-regional therapy [3,5].…”

“…The prevalence of postthrombotic syndrome also was lower, 27%, with catheterdirected administration often followed by adjunct therapy [20][21][22] compared with 57% [3,23] and 72% [3,5] (Table II). Any bleeding with catheter-directed thrombolytic therapy alone occurred in 6 of 20 (30%) [1,18] and with catheter-directed followed by adjunct therapy any bleeding occurred in 49 of 163 (30%) [10,[19][20][21][22] compared with 40 of 248 (16%) with systemic infusions [3,[23][24][25][26][27]] and 7 of 146 (5%) with local-regional therapy [3,5]. Most of the bleeding was minor and in those who had invasive approaches was usually at the site of catheter insertion.…”

“…Early recurrent PE occurred in 8% receiving systemic thrombolytic therapy [3,23,27] and in 1% with catheter-directed thrombolysis in combination with adjunct therapy [9,10,[19][20][21][22] (Table IV). The prevalence of PE after catheter directed thrombolysis alone was 20%, but the occurrence of early PE was evaluated in only 20 patients [1,18].…”

“…a Systemic heparin was administered with thrombolytic therapy [1,[3][4][5]9,10,[17][18][19][20][21][22]23,24], with thrombolytic therapy in 32% and after 24 hr in all patients [25], and after 72 hr in all patients [26].…”