A comparative randomized trial of heparin versus streptokinase in the treatment of acute proximal venous thrombosis: An interim report of a prospective trial

Abstract

A controlled, prospective study comparing streptokinase and heparin treatment has been completed in 51 patients presenting with acute proximal venous thrombosis of less than 8 days' clinical duration. Patients were studied by means of pre-treatment, post-treatment, 3- and 12-monthly phlebography and pulmonary perfusion scanning and were followed up at 3-monthly intervals. Of the 26 patients randomized to receive streptokinase, therapy was stopped in 3 because of complications. Phlebography 5 days after starting treatment showed 80--100 per cent lysis in 17 of the 23 patients who completed the course of streptokinase. Two patients later developed partial rethrombosis. One patient developed an asymptomatic pulmonary embolus during treatment. During follow-up (mean 19 months) only 1 of the 17 patients with 80--100 per cent lysis developed postphlebitic symptoms, 3 patients died of unrelated causes and 1 patient was lost to follow-up. In patients randomized to heparin therapy no significant lysis was achieved in any of the 25 patients and only 2 of these patients were found to have asymptomatic legs on follow-up. Two patients in this group died and autopsy confirmed massive pulmonary embolus during treatment. These data suggest that streptokinase is superior to heparin in the treatment of acute proximal venous thrombosis of less than 1 week's clinical duration especially if the thrombus is largely non-occlusive. It must be stressed that in order to avoid the bleeding complications of thrombolytic therapy, streptokinase must not be used within 10 days of major surgery, or even longer after vascular, neurosurgical or eye operations.

The Postthrombotic Syndrome: Evidence-Based Prevention, Diagnosis, and Treatment Strategies

“…Although several studies have compared systemically delivered thrombolytics with anticoagulation alone for DVT, few evaluated the occurrence of PTS as a primary outcome. [93][94][95][96] Although this limited number of studies suggested a reduction in PTS, the risk of major bleeding was greater with systemic thrombolysis than with anticoagulation alone or CDT. 96,97 Moreover, there is a nontrivial failure rate of systemic thrombolysis resulting, in part, from the poor concentration and penetration of thrombolytics within the thrombus itself.…”

Postphlebitic syndrome after hip arthroplasty: 43 patients followed at least 5 years

“…Thrombolytic therapy for proximal thrombosis does produce thrombolysis and at follow-up prevents the development of postphlebitic limb (Amesen et at. 1978at. , Elliot et at.…”

Endovascular Procedures in the Management of DVT

“…17 Two follow-up studies subsequently observed that PTS developed less frequently in patients treated with streptokinase compared with heparin alone at long-term follow-up, but these studies were small and did not use validated outcome measures of PTS. 18,19 In addition, bleeding complications were frequent (14% vs 4% in a pooled analysis) in the patients treated with streptokinase. 17 For this reason, systemic streptokinase infusions are not used for DVT treatment in current practice.…”