Skip to main content
PMC home page
Canadian Medical Association Journal logoLink to Canadian Medical Association Journal
. 1971 Mar 20;104(6):488-491, 516.

Comparison of the Effects of Streptokinase and Heparin on the Early Rate of Resolution of Major Pulmonary Embolism

J Hirsh, I G McDonald, G A Hale, E F O'Sullivan, V M Jelinek
PMCID: PMC1930899  PMID: 5549989

Abstract

The extent of early resolution of major pulmonary embolism observed in 10 patients after 24 hours of treatment with heparin was compared with that seen in 17 patients after 24 hours of treatment with streptokinase. The patients in the streptokinase group also received a loading dose of heparin and were treated with heparin by continuous infusion when their thrombin time returned to normal levels. All had pulmonary hypertension. Pulmonary embolism was classified as acute in the 10 patients in the heparin group. Seven of these patients showed no angiographic change, two showed slight improvement and one showed angiographic deterioration. There was a moderate and statistically insignificant fall in mean pulmonary arterial pressure and total pulmonary resistance. Fourteen of the 17 patients who were studied before and after streptokinase were classified as acute and three as subacute progressive major pulmonary embolism. Eight showed marked angiographic improvement, four moderate and two slight angiographic improvement. There was a moderate and statistically significant fall in the mean pulmonary arterial pressure and pulmonary vascular resistance. In addition, all seven patients in whom no angiographic improvement occurred during heparin therapy showed moderate or marked angiographic improvement after a further 24 hours of treatment with streptokinase. The results strongly suggest that streptokinase therapy accelerates thrombolysis in patients with acute major pulmonary embolism.

Full text

PDF
488

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. Cooley D. A., Beall A. C., Jr Embolectomy for acute massive pulmonary embolism. Surg Gynecol Obstet. 1968 Apr;126(4):805–810. [PubMed] [Google Scholar]
  4. DONALDSON G. A., WILLIAMS C., SCANNELL J. G., SHAW R. S. A reappraisal of the application of the Trendelenburg operation to massive fatal embolism. Report of a successful pulmonary-artery thrombectomy using a cardiopulmonary bypass. N Engl J Med. 1963 Jan 24;268:171–174. doi: 10.1056/NEJM196301242680402. [DOI] [PubMed] [Google Scholar]
  5. Dalen J. E., Mathur V. S., Evans H., Haynes F. W., Pur-Shahriari A. A., Stein P. D., Dexter L. Pulmonary angiography in experimental pulmonary embolism. Am Heart J. 1966 Oct;72(4):509–520. doi: 10.1016/0002-8703(66)90108-6. [DOI] [PubMed] [Google Scholar]
  6. Genton E., Wolf P. S. Urokinase therapy in pulmonary thromboembolism. Am Heart J. 1968 Nov;76(5):628–637. doi: 10.1016/0002-8703(68)90161-0. [DOI] [PubMed] [Google Scholar]
  7. 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]
  8. Hirsh J., O'Sullivan E. F., Martin M. Evaluation of a standard dosage schedule with streptokinase. Blood. 1970 Mar;35(3):341–349. [PubMed] [Google Scholar]
  9. Miller G. A., Gibson R. V., Honey M., Sutton G. C. Treatment of pulmonary embolism with streptokinase. A preliminary report. Br Med J. 1969 Mar 29;1(5647):812–815. doi: 10.1136/bmj.1.5647.812. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. O'Sullivan E. F., Hirsh J., McCarthy R. A., de Gruchy G. C. Heparin in the treatment of venous thrombo-embolic disease: administration, control and results. Med J Aust. 1968 Jul 27;2(4):153–159. doi: 10.5694/j.1326-5377.1968.tb29378.x. [DOI] [PubMed] [Google Scholar]
  11. Sasahara A. A., Cannilla J. E., Belko J. S., Morse R. L., Criss A. J. Urokinase therapy in clinical pulmonary embolism. A new thrombolytic agent. N Engl J Med. 1967 Nov 30;277(22):1168–1173. doi: 10.1056/NEJM196711302772203. [DOI] [PubMed] [Google Scholar]
  12. Sherry S. Fibrinolysis. Annu Rev Med. 1968;19:247–268. doi: 10.1146/annurev.me.19.020168.001335. [DOI] [PubMed] [Google Scholar]
  13. Tow D. E., Wagner H. N., Jr, Holmes R. A. Urokinase in pulnonary embolism. N Engl J Med. 1967 Nov 30;277(22):1161–1167. doi: 10.1056/NEJM196711302772202. [DOI] [PubMed] [Google Scholar]

Articles from Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association

RESOURCES