Treatment of Venous Thrombosis and Pulmonary Embolism by Streptokinase A.
Serradimigni, I.
Bory, P. Djiane, P. Mathieu, J. Leonetti, Juhan/Vague, and J. Sampol M.
MARSEILLE,
FRANCE
The efficacy of streptokinase (SK) is by and large proven’-&dquo; and its general contraindications’ are well defined. However, practical methods of application and indications are still in question. Drawing from our experience and from published data, we would like to comment on its use in pulmonary embolism and deep venous thrombosis. Materials and Methods
Patients. We treated 58 patients, 34 men and 24 women, aged between 22 and 93 with an average age of 55. Twenty-three had deep venous thrombosis, 6 had pulmonary embolism, and 29 had pulmonary embolism associated with venous thrombosis. A clot was found in the veins of the lower limbs 52 times and in pulmonary arteries 35 times. Because of the severity of their illness, determined by phlebography and angiography, these patients were given throm-
bolytic therapy. Administration of Streptokinase. We used streptokinase manufactured by Hoescht (Streptase). The product was administered by continuous intravenous infusion using a Logeais pump. All patients received a loading dose of 250,000 units in 30 minutes, and a maintenance dose of 100,000 units per hour. In addition, 100 mg of hydrocortisone hemisuccinate were injected before therapy was begun and every 6 hours thereafter. The duration of treatment varied between 18 and 80 hours, with an average of 42 hours. Heparin was administered after streptokinase therapy to maintain a hypocoagulable state (Howell time twice normal). Assessment of Treatment. To judge the value of the treatment, we considered the biologic and radiologic results. Biologic Results. In most patients fibrinolysis and coagulation are monitored by repetition of the following tests: Howell time, fibrinogen level, thrombin time, FDP, and thromboelastogram. But we used only the fibrinogen level because it seems to be the simplest and most accurate test of fibrinolysis. This test was conducted before therapy and every 6 hours during therapy. We established the following categories of fibrinolysis: Good-the level of fibrinogen fell below 1 g at the sixth hour and remained at this level throughout 825
Downloaded from ang.sagepub.com at UNIVERSITE DE SHERBROOKE on May 3, 2015
&dquo;. &dquo;
..
.
826 .
Global Results in
Deep
TABLE 1 Venous Thrombosis and
Pulmonary
Embolism
the treatment
period; Unchanged-the level of fibrinogen remained unaltered by treatment; Inadequate-the level of fibrinogen fell below 1 g either belatedly (after the sixth hour) or transiently, and rose to a higher level before the end of treatment.
Radiologic Results. In all patients the diagnosis was established either by phlebography (in cases of venous thrombosis) or angiography. These examinations were repeated within 48 hours of the end of treatment to evaluate the effect upon the clots. In 29 patients suffering from pulmonary embolism, phlebography and angiography were performed during the same operation, before and after treatment.
Phlebography. We use the technique of ascending phlebography. The contrast medium is injected into a vein in the sole of the foot. A tourniquet is then applied to the ankle to opacify the deep veins. Films are taken successively for the sural, popliteal, femoral, and femoroiliac veins; Then the femoral vein is compressed, and the leg is raised to an angle of 45°. A seriography (one film per second for 4 seconds) centred on the inferior vena cava was taken at the same time that the femoral compression was released. We divide the veins of the lower limbs into nine segments: right and left sural, right and left popliteal, right and left femoral, right and left iliac, and inferior
vena cava.
patients suffering from pulmonary embolism underwent catheterization to measure pulmonary artery pressure and right heart pressure. The contrast medium was injected into the pulmonary artery. We judged the extent of embolism based on the percentage of amputation of the Pulmonary Angiography.
All
TABLE 2
Radiologic
The difference is
Results
of Groups I, II, and III Arranged According
significant (P
Serradimigni, I.
Bory, P. Djiane, P. Mathieu, J. Leonetti, Juhan/Vague, and J. Sampol M.
MARSEILLE,
FRANCE
The efficacy of streptokinase (SK) is by and large proven’-&dquo; and its general contraindications’ are well defined. However, practical methods of application and indications are still in question. Drawing from our experience and from published data, we would like to comment on its use in pulmonary embolism and deep venous thrombosis. Materials and Methods
Patients. We treated 58 patients, 34 men and 24 women, aged between 22 and 93 with an average age of 55. Twenty-three had deep venous thrombosis, 6 had pulmonary embolism, and 29 had pulmonary embolism associated with venous thrombosis. A clot was found in the veins of the lower limbs 52 times and in pulmonary arteries 35 times. Because of the severity of their illness, determined by phlebography and angiography, these patients were given throm-
bolytic therapy. Administration of Streptokinase. We used streptokinase manufactured by Hoescht (Streptase). The product was administered by continuous intravenous infusion using a Logeais pump. All patients received a loading dose of 250,000 units in 30 minutes, and a maintenance dose of 100,000 units per hour. In addition, 100 mg of hydrocortisone hemisuccinate were injected before therapy was begun and every 6 hours thereafter. The duration of treatment varied between 18 and 80 hours, with an average of 42 hours. Heparin was administered after streptokinase therapy to maintain a hypocoagulable state (Howell time twice normal). Assessment of Treatment. To judge the value of the treatment, we considered the biologic and radiologic results. Biologic Results. In most patients fibrinolysis and coagulation are monitored by repetition of the following tests: Howell time, fibrinogen level, thrombin time, FDP, and thromboelastogram. But we used only the fibrinogen level because it seems to be the simplest and most accurate test of fibrinolysis. This test was conducted before therapy and every 6 hours during therapy. We established the following categories of fibrinolysis: Good-the level of fibrinogen fell below 1 g at the sixth hour and remained at this level throughout 825
Downloaded from ang.sagepub.com at UNIVERSITE DE SHERBROOKE on May 3, 2015
&dquo;. &dquo;
..
.
826 .
Global Results in
Deep
TABLE 1 Venous Thrombosis and
Pulmonary
Embolism
the treatment
period; Unchanged-the level of fibrinogen remained unaltered by treatment; Inadequate-the level of fibrinogen fell below 1 g either belatedly (after the sixth hour) or transiently, and rose to a higher level before the end of treatment.
Radiologic Results. In all patients the diagnosis was established either by phlebography (in cases of venous thrombosis) or angiography. These examinations were repeated within 48 hours of the end of treatment to evaluate the effect upon the clots. In 29 patients suffering from pulmonary embolism, phlebography and angiography were performed during the same operation, before and after treatment.
Phlebography. We use the technique of ascending phlebography. The contrast medium is injected into a vein in the sole of the foot. A tourniquet is then applied to the ankle to opacify the deep veins. Films are taken successively for the sural, popliteal, femoral, and femoroiliac veins; Then the femoral vein is compressed, and the leg is raised to an angle of 45°. A seriography (one film per second for 4 seconds) centred on the inferior vena cava was taken at the same time that the femoral compression was released. We divide the veins of the lower limbs into nine segments: right and left sural, right and left popliteal, right and left femoral, right and left iliac, and inferior
vena cava.
patients suffering from pulmonary embolism underwent catheterization to measure pulmonary artery pressure and right heart pressure. The contrast medium was injected into the pulmonary artery. We judged the extent of embolism based on the percentage of amputation of the Pulmonary Angiography.
All
TABLE 2
Radiologic
The difference is
Results
of Groups I, II, and III Arranged According
significant (P
