Low-dose fibrinolytic therapy. Results and new concepts.

Abstract

Experiences with the first 57 infusions (50 patients) in an ongoing study of local low-dose fibrinolysis [streptokinase and urokinase] for treatment of thromboembolic disease are reported. Complete lysis occurred in nearly 1/2 of the cases, while some therapeutic effect was demonstrable in more than 2/3. Success seems to be most directly related to the type of vessel infused, with the greatest success seen in vessels with no alternate pathways for egress of the fibrinolytic agent. Chronic fibrin deposits could also be treated with this technique. Since new thrombus formation occurs in a significant percentage of patients during local fibrinolytic therapy, cautious use of concomitant continuous i.v. heparin at a dosage sufficient to maintain the partial thromboplastin time at 1.5 times normal is recommended. While fibrinolytic therapy is usually not curative, it frequently facilitates detection of the underlying lesion, permitting definitive therapy.