Abstract
To test the efficacy of thrombolytic therapy in massive pulmonary embolism, we conducted a prospective randomized controlled trial. Eight patients were randomized to receive either 1,500,000 IU of streptokinase in 1 hour through a peripheral vein followed by heparin or heparin alone. All patients had major risk factors for deep vein thrombosis (DVT) and were considered to have high clinical suspicion for pulmonary embolism (PE). At baseline all patients had a similar degree of systemic arterial hypotension, pulmonary arterial hypertension, and right ventricular dysfunction. The time of onset of cardiogenic shock in both groups was comparable (2.25 ±0.5 hours in the streptokinase group and 1.75 ±0.96 hours in the heparin group). The four patients who were randomized to streptokinase improved in the first hour after treatment, survived, and in 2 years of follow-up are without pulmonary arterial hypertension. All four patients treated with heparin alone died from 1 to 3 hours after arrival at the emergency room (p=0.02). Post-thrombolytic therapy the diagnosis of PE was sustained in the streptokinase group by high probability V/Q lung scans and proven DVT. A necropsy study performed in three patients in the heparin group showed massive pulmonary embolism and right ventricular myocardial infarction, without significant coronary arterial obstruction. The results indicate that thrombolytic therapy reduces the mortality rate of massive acute pulmonary embolism.
Similar content being viewed by others
References
Levine MN, Goldhaber SZ, Califf RN, Gore JM, Hirsh J. Hemorrhagic complications of thrombolytic therapy in the treatment of myocardial infarction and venous thromboembolism.Chest 1992;102:364S-373S.
Jerjes-Sanchez C, Ramirez-Rivera A, Pimentel GM, Arriaga R. Dosis altas e infusion rapida de estreptoquinasa para el trata miento de tromboembolia pulmonar masiva.Arch Inst Cardiol Mex 1993;63:227–234.
The PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism: Results of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED).JAMA 1990;262:2753–2759.
Come PC. Echocardiographic evaluation of pulmonary embolism and its response to therapeutic interventions.Chest 1992;101:151S-162S.
Hull RD, Hirsh J, Carter CJ, et al. Pulmonary angiography, ventilation lung scanning and venography for clinically suspected pulmonary embolism with abnormal perfusion lung scan.Ann Intern Med 1983;98:891–899.
Actams NJE III, Siegel BA, Goldstein UA, Jaffe AS. Elevation of CK-MB following pulmonary embolism. A manifestation of occult right ventricular infarction.Chest 1992;101:1203–1206.
Goldhaber SZ, Haire WD, Feldstein ML, et al. Alteplase versus heparin in acute pulmonary embolism; randomised trial assessing right-ventricular function and pulmonary perfusion.Lancet 1993;341:507–511.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Jerjes-Sanchez, C., Ramírez-Rivera, A., de Lourdes García, M. et al. Streptokinase and heparin versus heparin alone in massive pulmonary embolism: A randomized controlled trial. J Thromb Thrombol 2, 227–229 (1995). https://doi.org/10.1007/BF01062714
Issue Date:
DOI: https://doi.org/10.1007/BF01062714