Efficacy of low-dose streptokinase in acute arterial occlusion and graft thrombosis
J. S. Kakkasseril, J. J. Cranley, J. J. Arbaugh, L. R. Roedersheimer and R. E. Welling
In a review of 35 patients undergoing local thrombolysis using selective
infusion of low-dose streptokinase, the overall success rate was 43%.
Streptokinase appears to be most effective in occlusion of native arteries,
in high-flow segments, and in autogenous saphenous vein grafts. Local
streptokinase was least effective in occluded prosthetic grafts in the
femoropopliteal segment (19% success). Distal embolization and progression
of thrombosis of the distal arterial tree may occur while the patient is
undergoing local thrombolysis and may result in limb loss. Hence, local
thrombolysis is not recommended when surgical treatment is an alternative.
Despite the low dose, systemic fibrinolytic effects and hemorrhagic
complications were common occurrences; hence, routine hematologic
monitoring is mandatory in patients undergoing lytic therapy with local
infusion of streptokinase.
