Streptokinase or Heparin in the Treatment of Deep Vein Thrombosis

Abstract

In a previous study on 42 patients with acute deep vein thrombosis, randomly allocated to treatment with streptokinase or heparin, we found that 71.4 % of the streptokinase-treated patients achieved phlebographically significant thrombolysis as compared to 23.8% in the heparin group. These patients have been reevaluated after a mean observation period of 64 years. Seven patients had died and there were no other drop-outs. Thus, 35 patients were subjected to the follow-up study consisting of phlebography and clinical examination. The evaluations were performed without knowledge of the initial therapy. Seven patients had phlebographically normal veins, and all belonged to the streptokinase group. This difference between the treatment groups is statistically highly significant (p cO.01). At clinical examination, 13 of the 17 patients in the streptokinase group had normal legs and 4 exhibited moderate postthrombotic changes. In contrast, 3 of the heparin-treated patients showed serious postthrombotic changes with open leg ulcers, and only 6 of 18 patients in this group had normal legs. The present results strongly support the assumption that streptokinase therapy is the best treatment at present in patients with acute deep vein thrombosis. This has been shown for the initial thrombolysis, and now also for the avoidance of late postthrombotic changes.

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.…”

Endovascular Interventions for Acute and Chronic Lower Extremity Deep Venous Disease: State of the Art

“…As discussed above, recurrent VTE is associated with the development of PTS. Finally, small randomized trials have observed the use of contemporary surgical venous thrombectomy and systemic thrombolysis to be associated with reduced PTS rates compared with anticoagulation alone, but at the price of greater invasiveness and more complications, including major bleeding (36)(37)(38)(39)(40)(41)(42).…”

Venous clot lysis and stenting

“…Although evidence of partial clot removal efficacy was demonstrated and two small, long-term follow-up studies with major methodological limitations did suggest a reduction in PTS, major bleeding was increased by 3-4 times over anticoagulation alone. [13][14][15] Therefore, systemic thrombolytic therapy is not recommended for the treatment of DVT. 3 CDT refers to the direct intrathrombus administration of a fibrinolytic drug via a catheter or device embedded within the thrombus using imaging guidance.…”