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. 1974 Mar 2;1(5904):343–347. doi: 10.1136/bmj.1.5904.343

Comparison by Controlled Clinical Trial of Streptokinase and Heparin in Treatment of Life-threatening Pulmonary Embolism

D A Tibbutt, J A Davies, J A Anderson, E W L Fletcher, J Hamill, J M Holt, M Lea Thomas, G De J Lee, G A H Miller, A A Sharp, G C Sutton
PMCID: PMC1633603  PMID: 4594580

Abstract

Treatment with heparin or streptokinase was allocated randomly to 30 patients with life-threatening pulmonary embolism verified by angiography. Treatment was given for 72 hours and pulmonary angiography was repeated. There was significantly greater (P < 0·001) evidence of thrombolysis in those patients treated with streptokinase compared with those treated with heparin. The reduction of systolic and mean pulmonary arterial pressures was also significantly greater (P < 0·05 and P < 0·02 respectively) in the streptokinase group.

Seven patients failed to complete 72 hours of the trial treatment: five successfully underwent pulmonary embolectomy. Six of these “failures” had initial pulmonary angiographic scores of 24 or more and systemic systolic blood pressure recordings of 100 mm Hg or less. Patients with these features should probably be considered for pulmonary embolectomy as the initial treatment.

A febrile reaction commonly occurred in the streptokinase group; otherwise side effects were no more common than in the heparin group.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BARRITT D. W., JORDAN S. C. Anticoagulant drugs in the treatment of pulmonary embolism. A controlled trial. Lancet. 1960 Jun 18;1(7138):1309–1312. doi: 10.1016/s0140-6736(60)92299-6. [DOI] [PubMed] [Google Scholar]
  2. Chait A., Summers D., Krasnow N., Wechsler B. M. Observations on the fate of large pulmonary emboli. Am J Roentgenol Radium Ther Nucl Med. 1967 Jun;100(2):364–373. doi: 10.2214/ajr.100.2.364. [DOI] [PubMed] [Google Scholar]
  3. Dalen J. E., Banas J. S., Jr, Brooks H. L., Evans G. L., Paraskos J. A., Dexter L. Resolution rate of acute pulmonary embolism in man. N Engl J Med. 1969 May 29;280(22):1194–1199. doi: 10.1056/NEJM196905292802202. [DOI] [PubMed] [Google Scholar]
  4. Fred H. L., Axelrad M. A., Lewis J. M., Alexander J. K. Rapid resolution of pulmonary thromboemboli in man. An angiographic study. JAMA. 1966 Jun 27;196(13):1137–1139. [PubMed] [Google Scholar]
  5. GUREWICH V., THOMAS D., STEIN M., WESSLER S. Bronchoconstriction in the presence of pulmonary embolism. Circulation. 1963 Mar;27:339–345. doi: 10.1161/01.cir.27.3.339. [DOI] [PubMed] [Google Scholar]
  6. Hirsh J., Hale G. S., McDonald I. G., McCarthy R. A., Pitt A. Streptokinase therapy in acute major pulmonary embolism: effectiveness and problems. Br Med J. 1968 Dec 21;4(5633):729–734. doi: 10.1136/bmj.4.5633.729. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Hirsh J., McDonald I. G., Hale G. A., O'Sullivan E. F., Jelinek V. M. Comparison of the effects of streptokinase and heparin on the early rate of resolution of major pulmonary embolism. Can Med Assoc J. 1971 Mar 20;104(6):488–passim. [PMC free article] [PubMed] [Google Scholar]
  8. Kakkar V. V., Raftery E. B. Selection of patients with pulmonary embolism for thrombolytic therapy. Lancet. 1970 Aug 1;2(7666):237–241. doi: 10.1016/s0140-6736(70)92587-0. [DOI] [PubMed] [Google Scholar]
  9. Miller G. A., Sutton G. C., Kerr I. H., Gibson R. V., Honey M. Comparison of streptokinase and heparin in treatment of isolated acute massive pulmonary embolism. Br Med J. 1971 Jun 19;2(5763):681–684. doi: 10.1136/bmj.2.5763.681. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Miller G. A. The diagnosis and management of massive pulmonary embolism. Br J Surg. 1972 Oct;59(10):837–839. doi: 10.1002/bjs.1800591025. [DOI] [PubMed] [Google Scholar]
  11. ROBERTSON J. D., REID D. D. Standards for the basal metabolism of normal people in Britain. Lancet. 1952 May 10;1(6715):940–943. doi: 10.1016/s0140-6736(52)90543-6. [DOI] [PubMed] [Google Scholar]
  12. ROSENBERG D. M., PEARCE C., MCNULTY J. SURGICAL TREATMENT OF PULMONARY EMBOLISM. J Thorac Cardiovasc Surg. 1964 Jan;47:1–16. [PubMed] [Google Scholar]
  13. SHARP A. A., EGGLETON M. J. HAEMATOLOGY AND THE EXTRACORPOREAL CIRCULATION. J Clin Pathol. 1963 Nov;16:551–557. doi: 10.1136/jcp.16.6.551. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Thomas D. P., Gurewich V., Ashford T. P. Platelet adherence to thromboemboli in relation to the pathogenesis and treatment of pulmonary embolism. N Engl J Med. 1966 Apr 28;274(17):953–956. doi: 10.1056/NEJM196604282741709. [DOI] [PubMed] [Google Scholar]
  15. Turnier E., Hill J. D., Kerth W. J., Gerbode F. Massive pulmonary embolism. Am J Surg. 1973 May;125(5):611–622. doi: 10.1016/0002-9610(73)90148-7. [DOI] [PubMed] [Google Scholar]

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