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The Journal of Cardiovascular Surgery 2002 December;43(6):881-5

language: English

Low dose systemic thrombolytic therapy for treatment of deep venous thrombosis

Ugurlu B., Kazaz H., Oto O., Hazan E., Sariosmanoglu N.

Dokuz Eylul University Medical School Department of Thoracic ­and Cardiovascular Surgery Izmir, Turkey


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Background. Thrombolytic ther­a­py is ­still ­not ­used wide­ly ­for treat­ment of ­deep ­vein throm­bo­sis ­despite ­its ­known effi­ca­cy. This reluc­tance to ­use it ­stems ­from wor­ries ­about ­its hemor­rhag­ic com­pli­ca­tions.
Methods. In a 4-­year peri­od 97 ­patients ­with ­deep ­vein throm­bo­sis diag­nosed by ­duplex ­study ­were ­enrolled ­into ­the ­study. Fifty ­patients ­received strep­tok­i­nase as a ­bolus of 250,000 ­units fol­lowed by 100,000 ­units/hr ­with a max­i­mum of 4,000,000 ­units ­and 47 ­patients ­received anti­co­ag­u­la­tion ­with hep­ar­in.
Results. Minor hemor­rhag­ic com­pli­ca­tions ­occurred in 2 ­patients (4%) in ­the throm­bo­lyt­ic ther­a­py ­group. An improve­ment in ­the con­trol ­duplex ­study ­was ­observed in 56% of ­the ­patients in ­the throm­bo­lyt­ic ther­a­py ­group com­pared to 5% in ­the hep­ar­in ­group (p=0.000). The ­patients treat­ed with­in 4 ­days of ­onset of symp­toms ­had sig­nif­i­cant­ly high­er suc­cess ­rates com­pared to ­those treat­ed lat­er (p=0.000). Higher suc­cess ­rates ­were ­obtained ­for ­those ­with ­either femo­ral ­vein or ­more dis­tal ­venous throm­bo­sis com­pared to ­those ­with ­iliac ­vein ­and ­vena ­cava throm­bo­sis (p=0.007). These ­results ­show ­that system­ic ­low ­dose strep­tok­i­nase ­achieves sig­nif­i­cant­ly high­er rec­a­nal­iza­tion ­rates com­pared to hep­ar­in ­alone. Conclusions. Hemorrhagic com­pli­ca­tions at ­these ­dose lev­els ­are with­in accept­able rang­es. Low ­dose strep­tok­i­nase reg­i­men ­could be beni­fi­cial in ­patients ­who ­present with­in 4 ­days of femo­ral or ­more dis­tal ­venous throm­bo­sis.

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